Provider Demographics
NPI:1972786234
Name:ASSOCIATES IN EYECARE BRISTOW PC
Entity Type:Organization
Organization Name:ASSOCIATES IN EYECARE BRISTOW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:HIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:VU-GIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-392-1010
Mailing Address - Street 1:10338 BRISTOW CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2201
Mailing Address - Country:US
Mailing Address - Phone:703-392-1010
Mailing Address - Fax:
Practice Address - Street 1:10338 BRISTOW CENTER DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2201
Practice Address - Country:US
Practice Address - Phone:703-392-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001000152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA110006Medicare PIN
VAV07971Medicare UPIN