Provider Demographics
NPI:1164505855
Name:ROSENTHAL, ALISON LEVIN (OD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:LEVIN
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:JEAN
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:19004 CASTLEGUARD CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6496
Mailing Address - Country:US
Mailing Address - Phone:703-669-0206
Mailing Address - Fax:
Practice Address - Street 1:21100 DULLES TOWN CIR
Practice Address - Street 2:SUITE 290
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2437
Practice Address - Country:US
Practice Address - Phone:703-421-3438
Practice Address - Fax:703-421-3428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist