Healthcare Provider Details

I. General information

NPI: 1669680476
Provider Name (Legal Business Name): VOORTHUIS OPTICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW
WASHINGTON DC
20016-3622
US

IV. Provider business mailing address

3301 NEW MEXICO AVE NW
WASHINGTON DC
20016-3622
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-5087
  • Fax: 202-363-5063
Mailing address:
  • Phone: 202-363-5087
  • Fax: 202-363-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP 826
License Number StateDC

VIII. Authorized Official

Name: MR. ALBERT BOUCHARD BEREND VOORTHUIS
Title or Position: PRESIDENT
Credential:
Phone: 202-363-5087