Healthcare Provider Details

I. General information

NPI: 1003995432
Provider Name (Legal Business Name): DEAN A. WRIGHT O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 09/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9665 MAIN ST
FAIRFAX VA
22031-3739
US

IV. Provider business mailing address

9665 MAIN ST
FAIRFAX VA
22031-3739
US

V. Phone/Fax

Practice location:
  • Phone: 703-978-2020
  • Fax: 703-978-6454
Mailing address:
  • Phone: 703-978-2020
  • Fax: 703-978-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001201
License Number StateVA

VIII. Authorized Official

Name: DR. DEAN AARTHUR WRIGHT
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 703-978-2020