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General NPI Number Information
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NPI Number | 1235311580
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Entity Type | Organization
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Legal Business Name | TOTAL VISION OPTOMETRIC CENTER, P.C.
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 4160 MERCHANT PLZ
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5085
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Country | US
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Telephone | 703-878-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 MERCHANT PLZ
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5085
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Country | US
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Telephone | 703-878-8818
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELISABETH KEUNROK KIM
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Credential | O.D.
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Telephone | 703-878-8878
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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 | 0618001424
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License Number State | VA
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