1235311580 NPI number — TOTAL VISION OPTOMETRIC CENTER, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235311580 NPI number — TOTAL VISION OPTOMETRIC CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL VISION OPTOMETRIC CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235311580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4160 MERCHANT PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22192-5085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-878-8818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 MERCHANT PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-5085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-878-8818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
ELISABETH
Authorized Official Middle Name:
KEUNROK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-878-8878

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618001424 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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