Provider Demographics
NPI:1790960359
Name:EYE CENTRAL, PC
Entity Type:Organization
Organization Name:EYE CENTRAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-356-1292
Mailing Address - Street 1:6740 OLD MCLEAN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3981
Mailing Address - Country:US
Mailing Address - Phone:703-356-1292
Mailing Address - Fax:703-356-1305
Practice Address - Street 1:6740 OLD MCLEAN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3981
Practice Address - Country:US
Practice Address - Phone:703-356-1292
Practice Address - Fax:703-356-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001003152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00526OtherMEDICARE GROUP PTAN
VAG00526OtherMEDICARE GROUP PTAN
VAT31192Medicare UPIN