MEDICARE: JING GUO, 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	0618000958	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316034945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JING GUO, O.D.

Provider Business Mailing Address
First Line	:	8703 ESQUIRE CROSSING LN
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-7088
Country	:	US
Telephone Number	:	571-261-4929
Fax Number	:

Provider Business Practice Location Address
First Line	:	7340 HERITAGE VILLAGE PLZ
Second Line	:	SUITE 102
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	571-261-4929
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JING GUO
Credential	:	O.D.
Telephone Number	:	571-261-4929

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	05/19/2011

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