Provider Demographics
NPI:1679121800
Name:ISHAK, GEORGE Z
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:Z
Last Name:ISHAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 MONTEGA DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5313
Mailing Address - Country:US
Mailing Address - Phone:703-586-8362
Mailing Address - Fax:
Practice Address - Street 1:1871 CARL D SILVER PKWY STE 1113
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4969
Practice Address - Country:US
Practice Address - Phone:540-786-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist