Provider Demographics
NPI:1497836381
Name:COLONIAL OPTICAL CO., INC.
Entity Type:Organization
Organization Name:COLONIAL OPTICAL CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:540-433-2642
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:210 UNIVERSITY BLVD.
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-0672
Mailing Address - Country:US
Mailing Address - Phone:540-433-2642
Mailing Address - Fax:540-433-2360
Practice Address - Street 1:210 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3748
Practice Address - Country:US
Practice Address - Phone:540-433-2642
Practice Address - Fax:540-433-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA242010OtherANTHEM B/C B/S
VA0288220001Medicare ID - Type Unspecified