1689008146 NPI number — RETINA SPECIALISTS OF VIRGINIA PLC

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 1689008146 NPI number — RETINA SPECIALISTS OF VIRGINIA PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA SPECIALISTS OF VIRGINIA PLC
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:
1689008146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 N WESTMORELAND ST
Provider Second Line Business Mailing Address:
UNIT 316
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22213-1044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-543-9808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 N WESTMORELAND ST
Provider Second Line Business Practice Location Address:
UNIT 316
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22213-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-543-9808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KURZ
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
703-543-9808

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0101251878 , 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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