Provider Demographics
NPI:1093257842
Name:WOODBRIDGE OPTOMETRIST INC
Entity Type:Organization
Organization Name:WOODBRIDGE OPTOMETRIST INC
Other - Org Name:VISUAL HEALTH DOCTORS OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-273-6323
Mailing Address - Street 1:19825 BELMONT CHASE DR
Mailing Address - Street 2:#165
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3417
Mailing Address - Country:US
Mailing Address - Phone:571-291-3604
Mailing Address - Fax:571-918-4916
Practice Address - Street 1:19825 BELMONT CHASE DR
Practice Address - Street 2:#165
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3417
Practice Address - Country:US
Practice Address - Phone:571-291-3604
Practice Address - Fax:571-918-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty