Healthcare Provider Details

I. General information

NPI: 1376723346
Provider Name (Legal Business Name): PRESTERA OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 CASTLE PL
FALLS CHURCH VA
22044-1905
US

IV. Provider business mailing address

6305 CASTLE PL
FALLS CHURCH VA
22044-1905
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-5464
  • Fax: 703-534-5815
Mailing address:
  • Phone: 703-534-5464
  • Fax: 703-534-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1101000519
License Number StateVA

VIII. Authorized Official

Name: MR. CHRISTPHER G PRESTERA
Title or Position: PRESIDENT
Credential: L.D.O.
Phone: 703-534-5464