MEDICARE: DR. AJIT D TIWARI OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618000571	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DN3306	OTHER	VA	MEDICARE RAILROAD
4	410040945	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3977120002	OTHER	VA	ADMINISTAR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053319293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJIT D TIWARI OD

Provider Business Mailing Address
First Line	:	300 S SYCAMORE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5041
Country	:	US
Telephone Number	:	804-732-5481
Fax Number	:	804-732-8675

Provider Business Practice Location Address
First Line	:	300 S SYCAMORE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5041
Country	:	US
Telephone Number	:	804-732-5481
Fax Number	:	804-732-8675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/10/2011

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