Provider Demographics
NPI:1386033215
Name:OLIVER OPTICIANS
Entity Type:Organization
Organization Name:OLIVER OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERON
Authorized Official - Middle Name:
Authorized Official - Last Name:TARESSA
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:703-567-0314
Mailing Address - Street 1:50 S PICKETT ST
Mailing Address - Street 2:29
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7207
Mailing Address - Country:US
Mailing Address - Phone:703-567-0314
Mailing Address - Fax:703-567-0384
Practice Address - Street 1:50 S PICKETT ST
Practice Address - Street 2:29
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7207
Practice Address - Country:US
Practice Address - Phone:703-567-0314
Practice Address - Fax:703-567-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service