Provider Demographics
NPI:1114292737
Name:EYECARE CENTER CORP
Entity Type:Organization
Organization Name:EYECARE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST / OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:MONCAYO
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC, LICENSED
Authorized Official - Phone:703-470-8274
Mailing Address - Street 1:3022 JAVIER RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4645
Mailing Address - Country:US
Mailing Address - Phone:703-470-8274
Mailing Address - Fax:
Practice Address - Street 1:4229 JEFFERSON OAKS CIR
Practice Address - Street 2:K
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4071
Practice Address - Country:US
Practice Address - Phone:703-470-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA