Healthcare Provider Details

I. General information

NPI: 1770943565
Provider Name (Legal Business Name): VIRGINIA RETINA SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD. SUITE 600
FALLS CHURCH VA
22042-2349
US

IV. Provider business mailing address

6400 ARLINGTON BLVD. SUITE 600
FALLS CHURCH VA
22042-2349
US

V. Phone/Fax

Practice location:
  • Phone: 703-288-9001
  • Fax: 703-288-5169
Mailing address:
  • Phone: 703-288-9001
  • Fax: 703-288-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: KHURRAM J. MALIK
Title or Position: AUTHORIZED REP/OWNER
Credential: MD
Phone: 703-288-9001