Healthcare Provider Details

I. General information

NPI: 1083768329
Provider Name (Legal Business Name): COLUMBUS EYE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 KING ST SUITE 100
ALEXANDRIA VA
22314-2944
US

IV. Provider business mailing address

7840 MONTGOMERY RD
CINCINNATI OH
45236-4301
US

V. Phone/Fax

Practice location:
  • Phone: 703-518-8913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KIRK
Title or Position: V.P. MANAGED CARE
Credential:
Phone: 800-688-4550