Provider Demographics
NPI:1275904674
Name:EYE SPECIALISTS AND SURGEONS OF NORTHERN VIRGINIA, LLC
Entity Type:Organization
Organization Name:EYE SPECIALISTS AND SURGEONS OF NORTHERN VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPHSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-417-8238
Mailing Address - Street 1:4000 LEGATO RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2892
Mailing Address - Country:US
Mailing Address - Phone:201-417-8238
Mailing Address - Fax:
Practice Address - Street 1:3998 FAIR RIDGE DR STE 105
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2980
Practice Address - Country:US
Practice Address - Phone:571-349-2191
Practice Address - Fax:571-349-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty