Healthcare Provider Details

I. General information

NPI: 1558368373
Provider Name (Legal Business Name): CHRYSTYNA P. KUZMOWYCH O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 WOODY LN
GREAT FALLS VA
22066-2024
US

IV. Provider business mailing address

9510 WOODY LN
GREAT FALLS VA
22066-2024
US

V. Phone/Fax

Practice location:
  • Phone: 703-759-4865
  • Fax: 703-757-9510
Mailing address:
  • Phone: 703-759-4865
  • Fax: 703-757-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: