Healthcare Provider Details

I. General information

NPI: 1689985889
Provider Name (Legal Business Name): PETER HUNG CAO ABOC/NCLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13955 METROTECH DR
CHANTILLY VA
20151-3239
US

IV. Provider business mailing address

13955 METROTECH DR
CHANTILLY VA
20151-3239
US

V. Phone/Fax

Practice location:
  • Phone: 703-378-2270
  • Fax:
Mailing address:
  • Phone: 703-378-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1101003250
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: