Provider Demographics
NPI:1437175684
Name:WASHINGTON NATIONAL EYE CENTER
Entity Type:Organization
Organization Name:WASHINGTON NATIONAL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUSTBADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-877-5329
Mailing Address - Street 1:110 IRVING STREET, NW
Mailing Address - Street 2:SUITE 1A-19
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2976
Mailing Address - Country:US
Mailing Address - Phone:202-877-5329
Mailing Address - Fax:202-877-7743
Practice Address - Street 1:110 IRVING STREET, NW
Practice Address - Street 2:SUITE 1A-19
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:202-877-5329
Practice Address - Fax:202-877-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC52132XXXX-53004998207W00000X
DC52132XXXX53004998207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD486621500OtherMARYLAND MEDICAID
MD486621500Medicaid
DC022986500Medicaid
DC9935OtherBCBS
DC022986500Medicaid