Provider Demographics
NPI:1134286974
Name:COLBOURNE, PAUL T (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:COLBOURNE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:10338 BRISTOW CENTER DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2201
Practice Address - Country:US
Practice Address - Phone:703-392-1010
Practice Address - Fax:703-392-4975
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV07971Medicare UPIN
VA009398T57Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
VAC083757Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER