Healthcare Provider Details

I. General information

NPI: 1700132511
Provider Name (Legal Business Name): RICHARD M. DAVIDSON, OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 TYSONS CORNER CTR
MC LEAN VA
22102-4525
US

IV. Provider business mailing address

8025 TYSONS CORNER CTR
MC LEAN VA
22102-4525
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-6586
  • Fax: 703-893-9379
Mailing address:
  • Phone: 703-893-6586
  • Fax: 703-893-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD MICHAEL DAVIDSON
Title or Position: OWNER
Credential: OD
Phone: 703-893-6586