Provider Demographics
NPI:1013331511
Name:M&MAK INC
Entity Type:Organization
Organization Name:M&MAK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIMMRTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:202-783-5318
Mailing Address - Street 1:801 PENNSYLVANIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-2615
Mailing Address - Country:US
Mailing Address - Phone:202-783-5318
Mailing Address - Fax:202-783-2020
Practice Address - Street 1:801 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-2615
Practice Address - Country:US
Practice Address - Phone:202-783-5318
Practice Address - Fax:202-783-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP000016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019338200Medicaid
DC019338200Medicaid