Provider Demographics
NPI:1912296005
Name:EYE CARE PHYSICIANS AND SURGEONS PC
Entity Type:Organization
Organization Name:EYE CARE PHYSICIANS AND SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GOLOVKINA-HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-831-1186
Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:755 S MAIN ST
Practice Address - Street 2:SUITE B01
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1143
Practice Address - Country:US
Practice Address - Phone:800-831-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADS5476OtherMEDICARE RAILROAD
VADS5476OtherMEDICARE RAILROAD