Provider Demographics
NPI:1710945035
Name:PILSKALNS, BEN ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:ANDREW
Last Name:PILSKALNS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:129 E FERRELL ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2101
Practice Address - Country:US
Practice Address - Phone:434-447-3220
Practice Address - Fax:434-447-2309
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5408T2319152W00000X
VA0618001558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010257042Medicaid
VA194021OtherANTHEM BCBS EMP PROV #
VA194019OtherANTHEM BCBS SOH PROV #
VAP00325745OtherRR MEDICARE INDIVIDUAL #
VA010285691Medicaid
VA5632440001Medicare NSC
VA00X068M02Medicare ID - Type Unspecified
VA010257042Medicaid
VA194019OtherANTHEM BCBS SOH PROV #