Provider Demographics
NPI:1104848050
Name:FS OPTOMETRY LLC
Entity Type:Organization
Organization Name:FS OPTOMETRY LLC
Other - Org Name:ASHBURN VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-724-9948
Mailing Address - Street 1:44075 PIPELINE PLZ
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5881
Mailing Address - Country:US
Mailing Address - Phone:703-724-9948
Mailing Address - Fax:703-724-9949
Practice Address - Street 1:44075 PIPELINE PLZ
Practice Address - Street 2:SUITE 205
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5881
Practice Address - Country:US
Practice Address - Phone:703-724-9948
Practice Address - Fax:703-724-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618001162OtherSTATE LICENSE
VAMH1231531OtherDEA
VAV04750Medicare UPIN
VA0618001162OtherSTATE LICENSE