Provider Demographics
NPI:1598014698
Name:DYSON, ERIN KEENEY (OD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KEENEY
Last Name:DYSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LAUREN
Other - Last Name:KEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
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:571-223-6780
Practice Address - Street 1:2401 N 16TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-2331
Practice Address - Country:US
Practice Address - Phone:409-886-2292
Practice Address - Fax:409-883-8012
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8057T152W00000X
TX8057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist