Provider Demographics
NPI:1790134807
Name:MOUGHON, WILLIAM REID (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:REID
Last Name:MOUGHON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-723-9633
Mailing Address - Fax:703-723-9772
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-723-9633
Practice Address - Fax:703-723-9772
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618002502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist