=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033388293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE EYE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2008
-----------------------------------------------------
Last Update Date | 02/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1471 CHAIN BRIDGE RD
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-5722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-356-1770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1471 CHAIN BRIDGE RD
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-5722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-356-1770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTICIAN
-----------------------------------------------------
Name | MS. MARILYN FRIEDKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-356-1770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 0002859599
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------