Provider Demographics
NPI:1225250673
Name:WILDMAN OPTICS INC
Entity Type:Organization
Organization Name:WILDMAN OPTICS INC
Other - Org Name:STERLING OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-266-9171
Mailing Address - Street 1:1325 ANNAPOLIS MALL
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3082
Mailing Address - Country:US
Mailing Address - Phone:410-266-9171
Mailing Address - Fax:410-266-7543
Practice Address - Street 1:1325 ANNAPOLIS MALL
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3082
Practice Address - Country:US
Practice Address - Phone:410-266-9171
Practice Address - Fax:410-266-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty