Healthcare Provider Details

I. General information

NPI: 1518292275
Provider Name (Legal Business Name): EYE PHYSICIANS AND SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 02/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 JAVIER RD STE 300
FAIRFAX VA
22031-4637
US

IV. Provider business mailing address

3031 JAVIER RD STE 300
FAIRFAX VA
22031-4637
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-8880
  • Fax: 703-698-8884
Mailing address:
  • Phone: 703-698-8880
  • Fax: 703-698-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN PHILLIP ESSEPIAN III
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 703-698-8880