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General NPI Number Information
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NPI Number | 1225783533
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Entity Type | Organization
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Legal Business Name | BRUSCO VISION LLC
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 3120 FAIRVIEW PARK DR STE 100
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City | FALLS CHURCH
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State | VA
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Zip | 22042-4570
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Country | US
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Telephone | 201-921-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 2302 COBBLE HILL TER
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City | SILVER SPRING
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State | MD
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Zip | 20902-7602
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Country | US
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Telephone | 201-921-4567
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL BRUSCO
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Credential | MD
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Telephone | 201-921-4567
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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 |
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License Number State |
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