Healthcare Provider Details

I. General information

NPI: 1427324870
Provider Name (Legal Business Name): WASHINGTON EYE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 011
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE STE 011
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-5200
  • Fax: 202-529-1476
Mailing address:
  • Phone: 202-529-5200
  • Fax: 202-529-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: THEODORE GANCAYCO
Title or Position: PHYSICIAN
Credential: MD
Phone: 202-529-5200