Provider Demographics
NPI:1447406681
Name:VISION SPECIALTY SERVICES LLC
Entity Type:Organization
Organization Name:VISION SPECIALTY SERVICES LLC
Other - Org Name:ANNAPOLIS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:M.
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-906-5039
Mailing Address - Street 1:13310 WICKLOW PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1439
Mailing Address - Country:US
Mailing Address - Phone:301-854-0864
Mailing Address - Fax:410-531-6815
Practice Address - Street 1:2331 FOREST DR STE A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3868
Practice Address - Country:US
Practice Address - Phone:410-224-8908
Practice Address - Fax:410-224-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty