Provider Demographics
NPI:1508822271
Name:CHHITWAL, ASHISH (OD)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:CHHITWAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10690 FAIRFAX BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4321
Mailing Address - Country:US
Mailing Address - Phone:703-273-6323
Mailing Address - Fax:703-273-6325
Practice Address - Street 1:10690
Practice Address - Street 2:FAIRFAX BLVD
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4379
Practice Address - Country:US
Practice Address - Phone:703-273-6323
Practice Address - Fax:703-273-6325
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU99195Medicare UPIN