Provider Demographics
NPI:1346360526
Name:DULLES TOWN CENTER OPTICAL, INC
Entity Type:Organization
Organization Name:DULLES TOWN CENTER OPTICAL, INC
Other - Org Name:STERLING OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-421-3359
Mailing Address - Street 1:1880 HOWARD AVE STE 301B
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2611
Mailing Address - Country:US
Mailing Address - Phone:703-761-4950
Mailing Address - Fax:703-761-9542
Practice Address - Street 1:21100 DULLES TOWN CIR STE 290
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2442
Practice Address - Country:US
Practice Address - Phone:703-421-3359
Practice Address - Fax:703-421-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB706258332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier