Provider Demographics
NPI:1013098748
Name:PEARLMAN, RUSSELL B (OD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:B
Last Name:PEARLMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:21475 RIDGETOP CIRCLE SUITE 300
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8580
Practice Address - Country:US
Practice Address - Phone:703-430-4400
Practice Address - Fax:703-430-4130
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618-000230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015868390001Medicaid
MD3461106-02Medicaid
VA1013098748Medicaid
WV150040000Medicaid
MD3461106-01Medicaid
VA0858550004Medicare NSC
VA0858550004Medicare NSC
VA203908OtherANTHEM BCBS/HEALTHKEEPERS
VA9233539Medicaid
VA9233547Medicaid
VA410037773Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD3461106-01Medicaid
VA9233326Medicaid
VA203907OtherANTHEM BCBS/HEALTHKEEPERS
VA9233334Medicaid
VA107425OtherANTHEM BCBS/HEALTHKEEPERS
VAU01912Medicare UPIN
MD3461106-02Medicaid
VA0858550001Medicare NSC