Healthcare Provider Details

I. General information

NPI: 1275624330
Provider Name (Legal Business Name): VISION SOURCE DC FOCUS EYECARE CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 17TH ST NW
WASHINGTON DC
20006-4802
US

IV. Provider business mailing address

614 17TH ST NW
WASHINGTON DC
20006-4802
US

V. Phone/Fax

Practice location:
  • Phone: 202-298-6878
  • Fax: 202-347-7180
Mailing address:
  • Phone: 202-298-6878
  • Fax: 202-347-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA ANNE SHUSTOCK
Title or Position: OWNER
Credential: O.D.
Phone: 202-298-6878