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General NPI Number Information
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NPI Number | 1225980931
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Entity Type | Organization
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Legal Business Name | PATRICIA CLUBB OD PLLC
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 10215 CARNOCH WAY SUITE 113
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City | BRISTOW
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State | VA
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Zip | 20136
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Country | US
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Telephone | 571-406-5588
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Fax |
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Provider Business Mailing Address
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Address Line | 14662 BATTERY RIDGE LN
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City | CENTREVILLE
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State | VA
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Zip | 20120-2896
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Country | US
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Telephone |
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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. PATRICIA CLUBB
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Credential | OD, MS
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Telephone | 571-723-8009
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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 |
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License Number State |
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