1457674152 NPI number — MEDICAL EYE CARE ASSOCIATES, PC

Table of content: (NPI 1457674152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457674152 NPI number — MEDICAL EYE CARE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL EYE CARE ASSOCIATES, PC
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:
1457674152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10410 MARBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22124-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-366-3555
Provider Business Mailing Address Fax Number:
703-355-3606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8717 DIGGES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-366-3555
Provider Business Practice Location Address Fax Number:
703-366-3606
Provider Enumeration Date:
03/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HAY
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
703-366-3555

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0101053808 , 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)

  • Identifier: 6305521 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com