Provider Demographics
NPI:1033302708
Name:THE EYECARE CENTER OPTOMETRISTS, P.C.
Entity Type:Organization
Organization Name:THE EYECARE CENTER OPTOMETRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-481-5600
Mailing Address - Street 1:13320 FRANKLIN FARM RD STE H
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4097
Mailing Address - Country:US
Mailing Address - Phone:703-481-5600
Mailing Address - Fax:703-437-4137
Practice Address - Street 1:13320 FRANKLIN FARM RD STE H
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4097
Practice Address - Country:US
Practice Address - Phone:703-481-5600
Practice Address - Fax:703-437-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0603000413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA626657Medicare PIN