Ed Optical LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

ED OPTICAL LLC

Practice address

3370 Leonardtown Rd
Suite 232
Waldorf, MD 20601-3624

Phone

(301) 885-0016

Fax

(206) 600-4463

NPI assigned

Mar 13, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Ayodele O Dayisi, DISPENSING OPTICIAN

Title

President/ Ceo

Phone

(301) 885-0016

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286409600000",
    "number": "1427299916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3370 LEONARDTOWN RD",
            "address_2": "SUITE 232",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013624",
            "telephone_number": "301-885-0016",
            "fax_number": "206-600-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3370 LEONARDTOWN RD",
            "address_2": "SUITE 232",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013624",
            "telephone_number": "301-885-0016",
            "fax_number": "206-600-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ED OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-13",
        "last_updated": "2010-10-07",
        "status": "A",
        "authorized_official_last_name": "DAYISI",
        "authorized_official_first_name": "AYODELE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "301-885-0016",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DISPENSING OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.