Provider Demographics
NPI:1013926880
Name:VINCENT BERTOMEU, OD, PC
Entity Type:Organization
Organization Name:VINCENT BERTOMEU, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENCENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BERTOMEU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-719-9110
Mailing Address - Street 1:6506 LOISDALE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1824
Mailing Address - Country:US
Mailing Address - Phone:703-719-9110
Mailing Address - Fax:703-719-9040
Practice Address - Street 1:6506 LOISDALE RD
Practice Address - Street 2:STE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1824
Practice Address - Country:US
Practice Address - Phone:703-719-9110
Practice Address - Fax:703-719-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
602107Medicare ID - Type Unspecified