Organization Name: | BRETON BAY OPTICAL SHOP, LLC |
NPI Number: | 1124407226 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LESLIE A MURPHY (MANAGER) |
Mailing Address: | 40845 Merchants Ln Suite 150 Leonardtown |
State: | MD US |
Postal Code: | 206503767 |
Phone Number: | 3019971822 |
Fax Number: | 3019971823 |
NPI Enumeration Date: | 05/21/2015 |
NPI Last Update Date: | 05/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |