Provider Demographics
NPI:1518361534
Name:NEW ERA EYECARE, LLC
Entity Type:Organization
Organization Name:NEW ERA EYECARE, LLC
Other - Org Name:NEW ERA EYECARE OPTOMETRIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:703-830-3977
Mailing Address - Street 1:5718 UNION MILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1088
Mailing Address - Country:US
Mailing Address - Phone:703-830-3977
Mailing Address - Fax:703-830-0714
Practice Address - Street 1:20789 GREAT FALLS PLZ STE 108
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-2483
Practice Address - Country:US
Practice Address - Phone:571-375-7950
Practice Address - Fax:571-375-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA061800670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
183485OtherMEDICARE PTAN
VA1891905253Medicaid
DC081542100Medicaid