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General NPI Number Information
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NPI Number | 1912164070
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Entity Type | Organization
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Legal Business Name | COLONIAL OPTICIANS OF POOLESVILLE INC.
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 718 CENTER POINT WAY
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City | GAITHERSBURG
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State | MD
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Zip | 20878-6469
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Country | US
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Telephone | 301-990-0398
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Fax | 303-990-9486
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Provider Business Mailing Address
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Address Line | 718 CENTER POINT WAY
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City | GAITHERSBURG
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State | MD
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Zip | 20878-6469
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Country | US
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Telephone | 301-990-0398
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Fax | 303-990-9486
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN MELISSA WILLIAMS
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Credential |
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Telephone | 301-657-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 15302753
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License Number State | MD
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