Healthcare Provider Details

I. General information

NPI: 1447467881
Provider Name (Legal Business Name): DR. VOORTHUIS, O.D. AND ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 KING ST
ALEXANDRIA VA
22314-3104
US

IV. Provider business mailing address

3301 NEW MEXICO AVE NW
WASHINGTON DC
20016-3622
US

V. Phone/Fax

Practice location:
  • Phone: 703-683-3822
  • Fax:
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 Number06018000927
License Number StateVA

VIII. Authorized Official

Name: DR. REBECCA CORINNE VOORTHUIS-GOLDMAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 703-683-3822