Provider Demographics
NPI:1639578529
Name:LARRY N LONDON OD
Entity Type:Organization
Organization Name:LARRY N LONDON OD
Other - Org Name:VIRGINIA VISION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOISSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-522-3454
Mailing Address - Street 1:3800 FAIRFAX DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1711
Mailing Address - Country:US
Mailing Address - Phone:703-522-3454
Mailing Address - Fax:703-522-9636
Practice Address - Street 1:3800 FAIRFAX DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1711
Practice Address - Country:US
Practice Address - Phone:703-522-3454
Practice Address - Fax:703-522-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACH7060OtherRAILROAD MEDICARE