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General NPI Number Information
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NPI Number | 1205024692
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Entity Type | Organization
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Legal Business Name | FAIRFAX EYE CENTER, PC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 3650 JOSEPH SIEWICK DR STE 303
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City | FAIRFAX
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State | VA
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Zip | 22033-1714
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Country | US
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Telephone | 508-801-5833
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Fax | 703-242-0919
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Provider Business Mailing Address
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Address Line | 2916 HIBBARD ST
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City | OAKTON
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State | VA
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Zip | 22124-2648
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Country | US
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Telephone | 508-801-5833
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Fax | 703-242-0919
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Authorized Official
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Title or Position | PRESIDENT AND OWNER
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Name | DR. HEATHER DIANNE HARTZELL
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Credential | M.D.
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Telephone | 508-801-5833
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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 | 0101239520
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License Number State | VA
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