Provider Demographics
NPI:1073688461
Name:COLONIAL OPTICIANS INC
Entity Type:Organization
Organization Name:COLONIAL OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:ALLNCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-881-7422
Mailing Address - Street 1:4942 ST ELMO AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6008
Mailing Address - Country:US
Mailing Address - Phone:301-657-3332
Mailing Address - Fax:301-657-4092
Practice Address - Street 1:4942 ST ELMO AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6008
Practice Address - Country:US
Practice Address - Phone:301-657-3332
Practice Address - Fax:301-657-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15214621332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0128770001Medicare NSC