Provider Demographics
NPI:1548403850
Name:KCYC CORP
Entity Type:Organization
Organization Name:KCYC CORP
Other - Org Name:ALL EYES OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KWON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-877-2020
Mailing Address - Street 1:3950 UNIVERSITY DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2565
Mailing Address - Country:US
Mailing Address - Phone:703-877-2020
Mailing Address - Fax:703-877-2212
Practice Address - Street 1:3950 UNIVERSITY DR
Practice Address - Street 2:SUITE 211
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2565
Practice Address - Country:US
Practice Address - Phone:703-877-2020
Practice Address - Fax:703-877-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC206137Medicare PIN