Provider Demographics
NPI:1003879834
Name:CULP, GORDON VINCENT JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:VINCENT
Last Name:CULP
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:44727 BRIMFIELD DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5920
Practice Address - Country:US
Practice Address - Phone:571-385-4600
Practice Address - Fax:571-385-4605
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2018-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X670L01Medicare PIN