Provider Demographics
NPI:1073619250
Name:NAZARIO, MARIE L (OD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17041 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2129
Mailing Address - Country:US
Mailing Address - Phone:703-221-2272
Mailing Address - Fax:
Practice Address - Street 1:17041 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2129
Practice Address - Country:US
Practice Address - Phone:703-221-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist