Provider Demographics
NPI:1215372321
Name:FAIRFAX EYE DOCS, LLC
Entity Type:Organization
Organization Name:FAIRFAX EYE DOCS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-691-7584
Mailing Address - Street 1:11011 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5002
Mailing Address - Country:US
Mailing Address - Phone:703-691-7584
Mailing Address - Fax:703-591-6271
Practice Address - Street 1:11011 LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5002
Practice Address - Country:US
Practice Address - Phone:703-691-7584
Practice Address - Fax:703-591-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty