Provider Demographics
NPI:1760696751
Name:STERLING OPTICAL
Entity Type:Organization
Organization Name:STERLING OPTICAL
Other - Org Name:M&M OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ONIMITZ
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-490-7772
Mailing Address - Street 1:3423 FORT MEADE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724
Mailing Address - Country:US
Mailing Address - Phone:301-776-2565
Mailing Address - Fax:
Practice Address - Street 1:3423 FORT MEADE RD STERLING OPTICAL
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724
Practice Address - Country:US
Practice Address - Phone:301-776-2565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty