Provider Demographics
NPI:1548307309
Name:M&D OPTICAL
Entity type:Organization
Organization Name:M&D OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:WANICUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-770-4310
Mailing Address - Street 1:501 N FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2507
Mailing Address - Country:US
Mailing Address - Phone:301-926-3933
Mailing Address - Fax:301-881-2945
Practice Address - Street 1:501 N FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2507
Practice Address - Country:US
Practice Address - Phone:301-926-3933
Practice Address - Fax:301-881-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1548307309OtherNPI
MD1017500001Medicare NSC
MDB93874Medicare UPIN