Healthcare Provider Details

I. General information

NPI: 1386033215
Provider Name (Legal Business Name): OLIVER OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S PICKETT ST 29
ALEXANDRIA VA
22304-7207
US

IV. Provider business mailing address

50 S PICKETT ST 29
ALEXANDRIA VA
22304-7207
US

V. Phone/Fax

Practice location:
  • Phone: 703-567-0314
  • Fax: 703-567-0384
Mailing address:
  • Phone: 703-567-0314
  • Fax: 703-567-0384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MERON TARESSA
Title or Position: OFFICE MANAGER
Credential: OFFICE MANAGER
Phone: 703-567-0314