=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083888333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARSHA C GAGE O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 EDWARDS FERRY RD NE
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 709-946-0517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18063 TAYLOR RD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20158-3543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-946-0517
-----------------------------------------------------
Fax | 540-751-0887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0618000384
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 0618000384
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------