1912296005 NPI number — EYE CARE PHYSICIANS AND SURGEONS PC

Table of content: (NPI 1912296005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912296005 NPI number — EYE CARE PHYSICIANS AND SURGEONS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE PHYSICIANS AND SURGEONS 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:
1912296005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 LINDEN DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-6900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-678-3588
Provider Business Mailing Address Fax Number:
540-678-9025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B01
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22664-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-831-1186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GOLOVKINA-HYNES
Authorized Official First Name:
ALLA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
800-831-1186

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , 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: DS5476 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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