MEDICARE: DR. ADRIANA SILVIA WISEMAN 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	OP1000262	DC
2	152W00000X	Optometrist	0601001497	VA
3	152WL0500X	Low Vision Rehabilitation Optometrist	OP1000262	DC
4	152WL0500X	Low Vision Rehabilitation Optometrist	0601001497	VA
5	152WL0500X	Low Vision Rehabilitation Optometrist	TA988	MD
6	152W00000X	Optometrist	TA988	MD

General Provider Information

NPI Number	:	1982817151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIANA SILVIA WISEMAN O.D.

Provider Business Mailing Address
First Line	:	PO BOX 15189
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20825-5189
Country	:	US
Telephone Number	:	240-203-9333
Fax Number	:	240-319-7376

Provider Business Practice Location Address
First Line	:	9160 BELVOIR WOODS PKWY
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-2703
Country	:	US
Telephone Number	:	240-203-9333
Fax Number	:	240-319-7376

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/21/2022

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