Healthcare Provider Details

I. General information

NPI: 1013320266
Provider Name (Legal Business Name): OPTIMEYES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43150 BROADLANDS CENTER PLZ SUITE 160
BROADLANDS VA
20148-3800
US

IV. Provider business mailing address

43150 BROADLANDS CENTER PLZ SUITE 160
BROADLANDS VA
20148-3800
US

V. Phone/Fax

Practice location:
  • Phone: 832-934-1166
  • Fax: 832-934-1161
Mailing address:
  • Phone: 832-934-1166
  • Fax: 832-934-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SEEMA MOHANAN
Title or Position: OD/OWNER
Credential: OD/OWNER
Phone: 215-840-2521