Provider Demographics
NPI:1073667648
Name:CREST OPTICIANS, INC.
Entity Type:Organization
Organization Name:CREST OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DELMAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNAO
Authorized Official - Phone:301-495-9156
Mailing Address - Street 1:8605 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2261
Mailing Address - Country:US
Mailing Address - Phone:301-495-9156
Mailing Address - Fax:301-495-9163
Practice Address - Street 1:8605 16TH ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2261
Practice Address - Country:US
Practice Address - Phone:301-495-9156
Practice Address - Fax:301-495-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15214838156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0711060001Medicare NSC