Healthcare Provider Details

I. General information

NPI: 1972580017
Provider Name (Legal Business Name): JOHN C. MCGUIRE III O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 GERMANNA HWY STE C
LOCUST GROVE VA
22508-2040
US

IV. Provider business mailing address

4207 GERMANNA HWY STE C
LOCUST GROVE VA
22508-2040
US

V. Phone/Fax

Practice location:
  • Phone: 540-972-6786
  • Fax:
Mailing address:
  • Phone: 540-972-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0601800407
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: