Provider Demographics
NPI:1518087543
Name:VISION CENTER OPTICIAN
Entity Type:Organization
Organization Name:VISION CENTER OPTICIAN
Other - Org Name:EYELAND EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-871-6454
Mailing Address - Street 1:12015 E ROCKVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-770-7084
Mailing Address - Fax:301-770-7085
Practice Address - Street 1:12015 E ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-770-7084
Practice Address - Fax:301-770-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA0890152W00000X
VA1101 003357156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty