MEDICARE: ASSOCIATES IN EYECARE STONE RIDGE PC

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

General Provider Information

NPI Number	:	1700014610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES IN EYECARE STONE RIDGE PC

Provider Business Mailing Address
First Line	:	42015 VILLAGE CENTER PLZ
Second Line	:	SUITE 103
City	:	STONE RIDGE
State	:	VA
Zip	:	20105-3033
Country	:	US
Telephone Number	:	703-542-8888
Fax Number	:	703-542-8856

Provider Business Practice Location Address
First Line	:	42015 VILLAGE CENTER PLZ
Second Line	:	SUITE 103
City	:	STONE RIDGE
State	:	VA
Zip	:	20105-3033
Country	:	US
Telephone Number	:	703-542-8888
Fax Number	:	703-542-8856

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIFFANY D LIONE
Credential	:	O.D.
Telephone Number	:	703-542-8888

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	03/10/2011

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