Healthcare Provider Details

I. General information

NPI: 1972786234
Provider Name (Legal Business Name): ASSOCIATES IN EYECARE BRISTOW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10338 BRISTOW CENTER DR
BRISTOW VA
20136-2201
US

IV. Provider business mailing address

10338 BRISTOW CENTER DR
BRISTOW VA
20136-2201
US

V. Phone/Fax

Practice location:
  • Phone: 703-392-1010
  • Fax:
Mailing address:
  • Phone: 703-392-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618001000
License Number StateVA

VIII. Authorized Official

Name: HIEU VU-GIA
Title or Position: DOCTOR OF OPTOMETRY
Credential: OD
Phone: 703-392-1010