Provider Demographics
NPI:1477741072
Name:DR. DAVID A. TUFTS, OD, PLLC
Entity Type:Organization
Organization Name:DR. DAVID A. TUFTS, OD, PLLC
Other - Org Name:CEDAR CREEK EYECARE, DOCTORS OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUFTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-662-0222
Mailing Address - Street 1:650 CEDAR CREEK GRADE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6452
Mailing Address - Country:US
Mailing Address - Phone:540-662-0222
Mailing Address - Fax:540-662-9365
Practice Address - Street 1:650 CEDAR CREEK GRADE
Practice Address - Street 2:SUITE 114
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6452
Practice Address - Country:US
Practice Address - Phone:540-662-0222
Practice Address - Fax:540-662-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1286320001Medicare NSC
VAC10455Medicare PIN