Provider Demographics
NPI:1093942427
Name:MOBIL OPTICAL STORE INC.
Entity Type:Organization
Organization Name:MOBIL OPTICAL STORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYLL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHNEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-986-1010
Mailing Address - Street 1:11140 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3106
Mailing Address - Country:US
Mailing Address - Phone:301-986-1010
Mailing Address - Fax:301-977-1931
Practice Address - Street 1:11140 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3106
Practice Address - Country:US
Practice Address - Phone:301-986-1010
Practice Address - Fax:301-977-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier