Provider Demographics
NPI:1316015399
Name:TYSONS CORNER OPHTHALMIC ASSOCIATES, LTD
Entity Type:Organization
Organization Name:TYSONS CORNER OPHTHALMIC ASSOCIATES, LTD
Other - Org Name:NORTHERN VIRGINIA CENTER FOR EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-790-1780
Mailing Address - Street 1:8150 LEESBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2714
Mailing Address - Country:US
Mailing Address - Phone:703-790-1780
Mailing Address - Fax:703-734-0491
Practice Address - Street 1:8150 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7715
Practice Address - Country:US
Practice Address - Phone:703-790-1780
Practice Address - Fax:703-734-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty