Organization Name: | MR OPTICAL, LLC |
NPI Number: | 1043369135 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL MYDLARZ (OPTICIAN) |
Mailing Address: | 70 Mill River St Stamford |
State: | CT US |
Postal Code: | 069023725 |
Phone Number: | 2033272020 |
Fax Number: | 2033273555 |
NPI Enumeration Date: | 01/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 001565 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |