Provider Demographics
NPI:1932183241
Name:VACHULA, STEVEN V II (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:V
Last Name:VACHULA
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:274 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3992
Practice Address - Country:US
Practice Address - Phone:413-584-6616
Practice Address - Fax:413-584-1951
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353361Medicaid
10267601OtherCIGNA HEALTH PLAN
38080OtherCHILDRENS MEDICAL SECURIT
W15678OtherBLUE SHIELD INDEMNITY
W15678OtherBLUE CARE ELECT
48391OtherFALLON COMMUNITY HEALTH
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
2009740002OtherCIGNA PAL ID
5882695OtherAETNA US HEALTHCARE
35481175OtherCIGNA HEALTHSOURCE
AA2842OtherHARVARD PILGRIM HEALTHCAR
042472266OtherTRICARE CHAMPUS
2213197OtherFIRST HEALTH
786732OtherMVP HEALTH CARE
W15678OtherBLUE SHIELD HMO BLUE
MA0353361Medicaid
042472266OtherPRIVATE HEALTHCARE SYSTEM
VA442358Medicare ID - Type UnspecifiedB
042472266OtherTRICARE CHAMPUS