Provider Demographics
NPI:1073783635
Name:EYE AND VISION CARE
Entity Type:Organization
Organization Name:EYE AND VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMPLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-961-9119
Mailing Address - Street 1:4221 WALNEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2987
Mailing Address - Country:US
Mailing Address - Phone:703-961-9119
Mailing Address - Fax:
Practice Address - Street 1:4221 WALNEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2987
Practice Address - Country:US
Practice Address - Phone:703-961-9119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU88560Medicare UPIN