Healthcare Provider Details

I. General information

NPI: 1437175684
Provider Name (Legal Business Name): WASHINGTON NATIONAL EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING STREET, NW SUITE 1A-19
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

110 IRVING STREET, NW SUITE 1A-19
WASHINGTON DC
20010-2976
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-5329
  • Fax: 202-877-7743
Mailing address:
  • Phone: 202-877-5329
  • Fax: 202-877-7743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number52132XXXX-53004998
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number52132XXXX53004998
License Number StateDC

VIII. Authorized Official

Name: DR. JAY M LUSTBADER
Title or Position: CHAIRMAN AND PRESIDENT
Credential: MD
Phone: 202-877-5329