Provider Demographics
NPI:1609017573
Name:BRISTOW OPTOMETRY, LLC
Entity Type:Organization
Organization Name:BRISTOW OPTOMETRY, LLC
Other - Org Name:MY EYE DR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAHMAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-847-8899
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:9930 SOWDER VILLAGE SQ
Practice Address - Street 2:SUITE 220
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5464
Practice Address - Country:US
Practice Address - Phone:703-368-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty