Provider Demographics
NPI:1447429444
Name:KOTECHA LASER & EYE CENTER
Entity Type:Organization
Organization Name:KOTECHA LASER & EYE CENTER
Other - Org Name:CAPITAL VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTECHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-886-6581
Mailing Address - Street 1:3801 FAIRFAX DR
Mailing Address - Street 2:SUITE 74
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1762
Mailing Address - Country:US
Mailing Address - Phone:703-528-3910
Mailing Address - Fax:703-528-4367
Practice Address - Street 1:3801 FAIRFAX DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:703-528-3910
Practice Address - Fax:703-528-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243040261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326019241Medicaid
H99990Medicare UPIN