Provider Demographics
NPI:1710004296
Name:DYNAMIC VISIONS INC
Entity Type:Organization
Organization Name:DYNAMIC VISIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OCTAVIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BONGAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-541-9270
Mailing Address - Street 1:7603 GEORGIA AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1617
Mailing Address - Country:US
Mailing Address - Phone:202-541-9270
Mailing Address - Fax:202-541-9272
Practice Address - Street 1:7603 GEORGIA AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1617
Practice Address - Country:US
Practice Address - Phone:202-541-9270
Practice Address - Fax:202-541-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC097054Medicare ID - Type UnspecifiedMEDICARE PROVIDER #