Provider Demographics
NPI:1003968538
Name:NORTHERN VIRGINIA OPHTHALMOLOGY ASSOC P.C
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA OPHTHALMOLOGY ASSOC P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-534-3900
Mailing Address - Street 1:6231 LEESBURG PIKE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2102
Mailing Address - Country:US
Mailing Address - Phone:703-534-5405
Mailing Address - Fax:703-534-9343
Practice Address - Street 1:6231 LEESBURG PIKE
Practice Address - Street 2:SUITE 608
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2102
Practice Address - Country:US
Practice Address - Phone:703-534-5405
Practice Address - Fax:703-534-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001432332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1127750001Medicare NSC