Provider Demographics
NPI:1801231279
Name:DUENAS, MICHAEL R (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:DUENAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1505 PRINCE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2852
Mailing Address - Country:US
Mailing Address - Phone:703-837-1008
Mailing Address - Fax:703-739-9497
Practice Address - Street 1:1505 PRINCE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2852
Practice Address - Country:US
Practice Address - Phone:703-837-1008
Practice Address - Fax:703-739-9497
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002715152W00000X
FL001734152W00000X
GA00996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist