Provider Demographics
NPI:1316034945
Name:JING GUO, O.D.
Entity Type:Organization
Organization Name:JING GUO, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:571-261-4929
Mailing Address - Street 1:8703 ESQUIRE CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7088
Mailing Address - Country:US
Mailing Address - Phone:571-261-4929
Mailing Address - Fax:
Practice Address - Street 1:7340 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3079
Practice Address - Country:US
Practice Address - Phone:571-261-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9233571Medicaid
VAV07651Medicare UPIN
VA9233571Medicaid