Provider Demographics
NPI:1659714137
Name:POLONCAK, ANN L (OD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:POLONCAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:CHRISTINE
Other - Last Name:LOFTUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
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 1:2823 CLARENDON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-2867
Practice Address - Country:US
Practice Address - Phone:703-294-6600
Practice Address - Fax:703-294-9980
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist