Provider Demographics
NPI:1801896402
Name:CHMIELEWSKI, PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CHMIELEWSKI
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 1:12 FAIRFAX ST SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3616
Mailing Address - Country:US
Mailing Address - Phone:703-777-1299
Mailing Address - Fax:703-777-5645
Practice Address - Street 1:12 FAIRFAX ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3616
Practice Address - Country:US
Practice Address - Phone:703-777-1299
Practice Address - Fax:703-777-5645
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001354152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010015448Medicaid
VA002560E18Medicare ID - Type Unspecified
VA010015448Medicaid