Provider Demographics
NPI:1316037559
Name:DANIEL POTH, O.D. AND ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DANIEL POTH, O.D. AND ASSOCIATES, P.C.
Other - Org Name:HOUR EYES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-288-1978
Mailing Address - Street 1:PO BOX 842375
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-2375
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:11903L LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:SUITE G133
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-218-8036
Practice Address - Fax:703-218-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9280081Medicaid
VA0900300022Medicare NSC