MEDICARE: DR. SYLVIA J BRICENO O.D.

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	0618001881	VA

General Provider Information

NPI Number	:	1285736454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYLVIA J BRICENO O.D.

Provider Business Mailing Address
First Line	:	25055 RIDING PLZ STE 100
Second Line	:
City	:	SOUTH RIDING
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-961-9119
Fax Number	:	703-961-9230

Provider Business Practice Location Address
First Line	:	25055 RIDING PLZ STE 100
Second Line	:
City	:	SOUTH RIDING
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-961-9119
Fax Number	:	703-961-9230

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	01/26/2017

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