Provider Demographics
NPI:1912164070
Name:COLONIAL OPTICIANS OF POOLESVILLE INC.
Entity Type:Organization
Organization Name:COLONIAL OPTICIANS OF POOLESVILLE INC.
Other - Org Name:COLONIAL OPTICIANS INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-657-3332
Mailing Address - Street 1:718 CENTER POINT WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6469
Mailing Address - Country:US
Mailing Address - Phone:301-990-0398
Mailing Address - Fax:303-990-9486
Practice Address - Street 1:718 CENTER POINT WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6469
Practice Address - Country:US
Practice Address - Phone:301-990-0398
Practice Address - Fax:303-990-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
MD15302753332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP0914OtherEYEMED
MDOP0914OtherEYEMED