Provider Demographics
NPI:1538649793
Name:BURWELL, CAITLIN GABRIELIA CHANEL (OD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:GABRIELIA CHANEL
Last Name:BURWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:1904 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5900
Practice Address - Country:US
Practice Address - Phone:252-492-9559
Practice Address - Fax:252-438-5581
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist