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General NPI Number Information
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NPI Number | 1285717785
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Entity Type | Organization
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Legal Business Name | DANIEL POTH, O.D. AND ASSOCIATES, P.C.
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 1841 FOUNTAIN DRIVE
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City | RESTON
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State | VA
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Zip | 20191
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Country | US
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Telephone | 703-471-1012
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Fax | 703-437-8384
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Provider Business Mailing Address
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Address Line | PO BOX 842375
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City | DALLAS
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State | TX
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Zip | 75284-2375
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Country | US
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Telephone | 210-524-6663
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Fax | 210-524-6587
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Authorized Official
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Title or Position | OWNER
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Name | DAN POTH
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Credential | O.D.
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Telephone | 703-288-1978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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