Provider Demographics
NPI:1114129996
Name:BLEND OPTICAL INC.
Entity Type:Organization
Organization Name:BLEND OPTICAL INC.
Other - Org Name:STERLING OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JADENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-359-2773
Mailing Address - Street 1:11702U FAIR OAKS MALL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3325
Mailing Address - Country:US
Mailing Address - Phone:703-359-2773
Mailing Address - Fax:703-359-2763
Practice Address - Street 1:11702U FAIR OAKS MALL
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3325
Practice Address - Country:US
Practice Address - Phone:703-359-2773
Practice Address - Fax:703-359-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty