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General NPI Number Information
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NPI Number | 1073688461
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Entity Type | Organization
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Legal Business Name | COLONIAL OPTICIANS INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 4942 ST ELMO AVE
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City | BETHESDA
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State | MD
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Zip | 20814-6008
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Country | US
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Telephone | 301-657-3332
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Fax | 301-657-4092
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Provider Business Mailing Address
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Address Line | 4942 ST ELMO AVE
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City | BETHESDA
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State | MD
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Zip | 20814-6008
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Country | US
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Telephone | 301-657-3332
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Fax | 301-657-4092
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Authorized Official
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Title or Position | PRESIDENT OPTICIAN
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Name | DEBRA WILLIAMS ALLNCETT
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Credential |
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Telephone | 301-881-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 15214621
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License Number State | MD
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