Healthcare Provider Details

I. General information

NPI: 1427796598
Provider Name (Legal Business Name): THE EYE CENTER OFFICE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 235
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 235
FAIRFAX VA
22031-5216
US

V. Phone/Fax

Practice location:
  • Phone: 703-430-4400
  • Fax:
Mailing address:
  • Phone: 703-430-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARIN GAB-ALLAH
Title or Position: BILLER
Credential:
Phone: 571-315-7402