Provider Demographics
NPI:1760562938
Name:PRINCE WILLIAM EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PRINCE WILLIAM EYE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-361-6151
Mailing Address - Street 1:8912 CENTREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8455
Mailing Address - Country:US
Mailing Address - Phone:703-361-6151
Mailing Address - Fax:
Practice Address - Street 1:8912 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8455
Practice Address - Country:US
Practice Address - Phone:703-361-6151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800450152W00000X
VA0618001663152W00000X
VA5456340001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5456340001Medicare NSC
VAC09364Medicare PIN