MEDICARE: COLONIAL OPTICIANS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	15214621	MD

General Provider Information

NPI Number	:	1073688461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL OPTICIANS INC

Provider Business Mailing Address
First Line	:	4942 ST ELMO AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-6008
Country	:	US
Telephone Number	:	301-657-3332
Fax Number	:	301-657-4092

Provider Business Practice Location Address
First Line	:	4942 ST ELMO AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-6008
Country	:	US
Telephone Number	:	301-657-3332
Fax Number	:	301-657-4092

Authorized Official
Title or Position	:	PRESIDENT OPTICIAN
Name	:	DEBRA WILLIAMS ALLNCETT
Credential	:
Telephone Number	:	301-881-7422

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/21/2008

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