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General NPI Number Information
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NPI Number | 1093869976
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Entity Type | Organization
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Legal Business Name | VIRGINIA RETINA CENTER LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 45 N HILL DR STE 202
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City | WARRENTON
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State | VA
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Zip | 20186-2677
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Country | US
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Telephone | 540-349-1882
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Fax | 703-738-7157
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Provider Business Mailing Address
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Address Line | 45 N HILL DR STE 202
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City | WARRENTON
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State | VA
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Zip | 20186-2677
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Country | US
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Telephone | 540-349-1882
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Fax | 703-738-7157
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JOANNE MANSOUR
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Credential |
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Telephone | 540-349-1882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01011233782
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License Number State | VA
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