=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275753055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE2EYE OPTOMETRY CORNER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 08/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1502 MOUNT VERNON AVE
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22301-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-548-0122
-----------------------------------------------------
Fax | 703-548-0133
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1502 MOUNT VERNON AVE
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22301-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-548-0122
-----------------------------------------------------
Fax | 703-548-0133
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DORA ADAMOPOULOS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 703-548-0122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0618000936
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------