Provider Demographics
NPI:1578741278
Name:ACCESS EYE CENTERS, PC
Entity Type:Organization
Organization Name:ACCESS EYE CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-371-2020
Mailing Address - Street 1:110 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1924
Mailing Address - Country:US
Mailing Address - Phone:540-371-2020
Mailing Address - Fax:540-373-0141
Practice Address - Street 1:4701 SPOTSYLVANIA PARKWAY
Practice Address - Street 2:STE #110
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9434
Practice Address - Country:US
Practice Address - Phone:540-371-2020
Practice Address - Fax:540-373-0141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS EYE CENTERS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-05
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 156FX1800X, 332H00000X
VA0101840394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0441780002Medicare NSC
VA0441780002Medicare NSC