Healthcare Provider Details

I. General information

NPI: 1952358020
Provider Name (Legal Business Name): EYE CONSULTANTS OF NORTHERN VIRGINIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 OLD KEENE MILL RD STE B300
SPRINGFIELD VA
22152-1856
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD STE B300
SPRINGFIELD VA
22152-1856
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-6111
  • Fax: 703-451-6247
Mailing address:
  • Phone: 703-763-0963
  • Fax: 703-451-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0439317
License Number StateVA

VIII. Authorized Official

Name: MS. TIENSA LUNDIEN
Title or Position: BILLING MANAGER
Credential:
Phone: 703-763-0963