Provider Demographics
NPI:1083637466
Name:CRYSTAL EYE CARE,INC
Entity Type:Organization
Organization Name:CRYSTAL EYE CARE,INC
Other - Org Name:JEFF C. CHUH, O.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHUH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-413-9001
Mailing Address - Street 1:1654 CRYSTAL SQUARE ARC
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3322
Mailing Address - Country:US
Mailing Address - Phone:703-413-9001
Mailing Address - Fax:703-552-1334
Practice Address - Street 1:1654 CRYSTAL SQUARE ARC
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3322
Practice Address - Country:US
Practice Address - Phone:703-413-9001
Practice Address - Fax:703-552-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009235434Medicaid