Provider Demographics
NPI:1114085099
Name:ARCHEY, HERBERT MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:MICHAEL
Last Name:ARCHEY
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 1:4109 WESTMAN CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1259
Mailing Address - Country:US
Mailing Address - Phone:703-765-2607
Mailing Address - Fax:703-765-2607
Practice Address - Street 1:3134 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4846
Practice Address - Country:US
Practice Address - Phone:301-374-9615
Practice Address - Fax:301-374-9616
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA1362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist