1285721431 NPI number — DOMINION EYE CARE, P.C.

Table of content: (NPI 1285721431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285721431 NPI number — DOMINION EYE CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINION EYE CARE, 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:
1285721431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8140 ASHTON AVE STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20109-5699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-361-3128
Provider Business Mailing Address Fax Number:
703-361-3670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8140 ASHTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-361-3128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
ELICIA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
703-361-3128

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 099706 . This is a "BCBS OF VA ANTHEM GRP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CG4422 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CG4422 . This is a "RAIL ROAD MEDICARE GRP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C01662 . This is a "TRAILBLAZER MEDICARE GRP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0757379 . This is a "CIGNA GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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