Provider Demographics
NPI:1275783235
Name:ADVANCED RETINA CENTER, LC
Entity Type:Organization
Organization Name:ADVANCED RETINA CENTER, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-917-0012
Mailing Address - Street 1:8233 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3816
Mailing Address - Country:US
Mailing Address - Phone:703-917-0012
Mailing Address - Fax:703-917-0028
Practice Address - Street 1:8233 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3816
Practice Address - Country:US
Practice Address - Phone:703-917-0012
Practice Address - Fax:703-917-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty