Provider Demographics
NPI:1114007408
Name:BLEAKLEY, NEIL MAGEE (OD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:MAGEE
Last Name:BLEAKLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39155 ALDIE RD
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2005
Mailing Address - Country:US
Mailing Address - Phone:703-421-3438
Mailing Address - Fax:703-421-3428
Practice Address - Street 1:DULLES TOWN CENTER MALL
Practice Address - Street 2:#290
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166
Practice Address - Country:US
Practice Address - Phone:703-421-3438
Practice Address - Fax:703-421-3428
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist