Provider Demographics
NPI:1588735609
Name:T&L OPTICAL SUPPLY INC.
Entity type:Organization
Organization Name:T&L OPTICAL SUPPLY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-795-8670
Mailing Address - Street 1:6300 GEORGETOWN BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6481
Mailing Address - Country:US
Mailing Address - Phone:410-795-8670
Mailing Address - Fax:410-795-2680
Practice Address - Street 1:6300 GEORGETOWN BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6481
Practice Address - Country:US
Practice Address - Phone:410-795-8670
Practice Address - Fax:410-795-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0683910001Medicare NSC
MDX522Medicare ID - Type Unspecified