Provider Demographics
NPI:1043369135
Name:MR OPTICAL, LLC
Entity type:Organization
Organization Name:MR OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MYDLARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-327-2020
Mailing Address - Street 1:70 MILL RIVER ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3725
Mailing Address - Country:US
Mailing Address - Phone:203-327-2020
Mailing Address - Fax:203-327-3555
Practice Address - Street 1:70 MILL RIVER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3725
Practice Address - Country:US
Practice Address - Phone:203-327-2020
Practice Address - Fax:203-327-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001565156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty