Provider Demographics
NPI:1912188319
Name:MCNELLY OPTICAL COMPNAY INC.
Entity Type:Organization
Organization Name:MCNELLY OPTICAL COMPNAY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-263-2571
Mailing Address - Street 1:703 GIDDINGS AVE
Mailing Address - Street 2:SUITE L6
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1411
Mailing Address - Country:US
Mailing Address - Phone:410-263-2571
Mailing Address - Fax:
Practice Address - Street 1:703 GIDDINGS AVE
Practice Address - Street 2:SUITE L6
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1411
Practice Address - Country:US
Practice Address - Phone:410-263-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02210330332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier