MEDICARE: DRS. UNWALLA & RUNKE, OPTOMETRISTS P.C.

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	0118000120	VA

General Provider Information

NPI Number	:	1841442217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. UNWALLA & RUNKE, OPTOMETRISTS P.C.

Provider Business Mailing Address
First Line	:	9909 GEORGETOWN PIKE
Second Line	:	P.O. BOX 409
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-2826
Country	:	US
Telephone Number	:	703-759-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	9909 GEORGETOWN PIKE
Second Line	:
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-2826
Country	:	US
Telephone Number	:	703-759-0061
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISTEN RUNKE
Credential	:	O.D.
Telephone Number	:	703-759-0061

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	12/24/2008

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