Provider Demographics
NPI:1578999314
Name:SURMATY, AIATULAH (OD)
Entity Type:Individual
Prefix:
First Name:AIATULAH
Middle Name:
Last Name:SURMATY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:AYATT
Other - Middle Name:
Other - Last Name:SURMATY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6506 LOISDALE ROAD
Mailing Address - Street 2:SUITE 102 (EYE TOWN VISION CENTER)
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150
Mailing Address - Country:US
Mailing Address - Phone:703-347-6633
Mailing Address - Fax:703-341-6782
Practice Address - Street 1:6506 LOISDALE RD STE 1O2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1824
Practice Address - Country:US
Practice Address - Phone:703-347-6633
Practice Address - Fax:703-341-6782
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002282152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics