Healthcare Provider Details

I. General information

NPI: 1407065832
Provider Name (Legal Business Name): SEE CLEARLY VISION GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8138 WATSON ST
MC LEAN VA
22102-4416
US

IV. Provider business mailing address

8138 WATSON ST
MC LEAN VA
22102-4416
US

V. Phone/Fax

Practice location:
  • Phone: 703-827-5454
  • Fax:
Mailing address:
  • Phone: 703-827-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618001062
License Number StateVA

VIII. Authorized Official

Name: RAJESH K RAJPAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-827-5454