Provider Demographics
NPI:1275730525
Name:TYSONS CORNER OPTICIANS INC
Entity Type:Organization
Organization Name:TYSONS CORNER OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:LETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-790-0803
Mailing Address - Street 1:8150 LEESBURG PIKE
Mailing Address - Street 2:SUITE 901
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-7750
Mailing Address - Country:US
Mailing Address - Phone:703-790-0803
Mailing Address - Fax:703-356-5639
Practice Address - Street 1:8150 LEESBURG PIKE
Practice Address - Street 2:SUITE 901
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7715
Practice Address - Country:US
Practice Address - Phone:703-790-0803
Practice Address - Fax:703-356-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001692156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0703900001Medicare ID - Type Unspecified