Healthcare Provider Details

I. General information

NPI: 1134437924
Provider Name (Legal Business Name): MITZY ATTOKAREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date: 12/07/2010
Reactivation Date: 04/09/2014

III. Provider practice location address

700 2ND ST NE
WASHINGTON DC
20002-8100
US

IV. Provider business mailing address

700 2ND ST NE
WASHINGTON DC
20002-8100
US

V. Phone/Fax

Practice location:
  • Phone: 202-346-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP1000156
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: