Healthcare Provider Details

I. General information

NPI: 1588696165
Provider Name (Legal Business Name): NANCY MARIA DRASKOVIC OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. NANCY MARIA DRASKOVIC DOSEN

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD SUITE 103
ALEXANDRIA VA
22306-3403
US

IV. Provider business mailing address

8101 HINSON FARM RD #103
ALEXANDRIA VA
22306-3403
US

V. Phone/Fax

Practice location:
  • Phone: 703-360-0111
  • Fax: 703-799-1126
Mailing address:
  • Phone: 703-360-0111
  • Fax: 703-799-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001347
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1621
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP10000045
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: