Provider Demographics
NPI:1891136156
Name:OMELIO OPTICAL LLC
Entity Type:Organization
Organization Name:OMELIO OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OMELIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-236-5032
Mailing Address - Street 1:6220 GEORGETOWN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6417
Mailing Address - Country:US
Mailing Address - Phone:410-236-5032
Mailing Address - Fax:
Practice Address - Street 1:6220 GEORGETOWN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6417
Practice Address - Country:US
Practice Address - Phone:410-236-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty