Basic Information
| Provider Information | |||||||||
| NPI: | 1215113592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MALAMUT OPTICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7756 LANDOVER RD | ||||||||
| Address2: | |||||||||
| City: | LANDOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207852135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017732828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7756 LANDOVER RD | ||||||||
| Address2: | |||||||||
| City: | LANDOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207852135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017732828 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 01/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOLD | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3018817775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.