Provider Demographics
NPI:1033106638
Name:BYRNES, ELENA C (OD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:C
Last Name:BYRNES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:KATHERINE
Other - Last Name:CECCATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8912 CENTREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8455
Mailing Address - Country:US
Mailing Address - Phone:703-361-6151
Mailing Address - Fax:703-361-1750
Practice Address - Street 1:8912 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8455
Practice Address - Country:US
Practice Address - Phone:703-361-6151
Practice Address - Fax:703-361-1750
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA176748OtherANTHEM
VAU84544Medicare UPIN
VA176748OtherANTHEM
VA5456340001Medicare NSC