Provider Demographics
NPI:1376723346
Name:PRESTERA OPTICAL INC.
Entity Type:Organization
Organization Name:PRESTERA OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRESTERA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:703-534-5464
Mailing Address - Street 1:6305 CASTLE PL
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1905
Mailing Address - Country:US
Mailing Address - Phone:703-534-5464
Mailing Address - Fax:703-534-5815
Practice Address - Street 1:6305 CASTLE PL
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1905
Practice Address - Country:US
Practice Address - Phone:703-534-5464
Practice Address - Fax:703-534-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VA1101000519332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0281150001Medicare PIN
VA0281150001Medicare NSC