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NPI Code Detail

MEDICARE: MS. COLLEEN M. WISNIEWSKI A.B.O.C. OPTICIAN

MEDICARE: MS. COLLEEN M. WISNIEWSKI A.B.O.C. OPTICIAN
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
1156FX1800XOptician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11992121669OTHERMDGROUP NPI

General Provider Information

NPI Number : 1093258006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COLLEEN M. WISNIEWSKI A.B.O.C. OPTICIAN
Provider Business Mailing Address
First Line : 10101 COLESVILLE RD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20901-2426
Country : US
Telephone Number : 301-754-0101
Fax Number : 301-754-0103
Provider Business Practice Location Address
First Line : 10101 COLESVILLE RD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20901-2426
Country : US
Telephone Number : 301-754-0101
Fax Number : 301-754-0103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2016
Last Update Date : 01/17/2017

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