Healthcare Provider Details

I. General information

NPI: 1992981492
Provider Name (Legal Business Name): OAKTON FOOT AND ANKLE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST STE 3500
FAIRFAX VA
22030-6909
US

IV. Provider business mailing address

10721 MAIN ST SUITE 3500
FAIRFAX VA
22030-6914
US

V. Phone/Fax

Practice location:
  • Phone: 703-352-8888
  • Fax: 703-352-8994
Mailing address:
  • Phone: 703-352-8888
  • Fax: 703-352-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0130000659
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN R VETTER
Title or Position: SOLE PROPRIETOR
Credential: DPM
Phone: 703-352-8888