Healthcare Provider Details

I. General information

NPI: 1366510786
Provider Name (Legal Business Name): LETICIA KHU OSWALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTH WASHINGTON STREET
FALLS CHURCH VA
22046-4518
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6 WEST
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-4020
  • Fax: 703-536-1395
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number0101033796
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: