Provider Demographics
NPI:1275306011
Name:OLE OPTICAL LABORATORY EXPRESS LLC
Entity Type:Organization
Organization Name:OLE OPTICAL LABORATORY EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:MONCAYO
Authorized Official - Suffix:
Authorized Official - Credentials:COMT
Authorized Official - Phone:703-420-8121
Mailing Address - Street 1:3577 SHADY PINES ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-6907
Mailing Address - Country:US
Mailing Address - Phone:202-603-9450
Mailing Address - Fax:
Practice Address - Street 1:8328 SHOPPERS SQ
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2174
Practice Address - Country:US
Practice Address - Phone:703-420-8121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier