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General NPI Number Information
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NPI Number | 1215073614
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Entity Type | Individual
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Provider Name | ALLAN GARY DOSIK O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6795B SPRINGFIELD MALL
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1704
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Country | US
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Telephone | 703-719-9198
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Fax | 703-719-9199
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Provider Business Mailing Address
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Address Line | 6200 28TH ST N
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City | ARLINGTON
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State | VA
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Zip | 22207-1110
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Country | US
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Telephone | 703-536-3663
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Fax | 703-536-3663
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601000973
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License Number State | VA
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