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Eye and Vision Services Providers Optometrist

Provider NPI: 1710067954

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 202-223-3530  Fax: 202-223-9748

Business Mailing Address:
Tel: 202-223-3530  Fax: 202-223-9748

NPI Information:
NPI: 1710067954
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
N152WC0802XEye and Vision Services Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 152W00000X





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