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General NPI Number Information
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NPI Number | 1306478490
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Entity Type | Organization
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Legal Business Name | DISTRICT EYECARE INC
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 3903 FAIR RIDGE DR UNIT E
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City | FAIRFAX
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State | VA
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Zip | 22033-2943
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Country | US
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Telephone | 703-961-9119
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Fax | 312-277-3735
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Provider Business Mailing Address
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Address Line | 3903 FAIR RIDGE DR UNIT E
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City | FAIRFAX
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State | VA
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Zip | 22033-2943
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Country | US
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Telephone | 703-961-9119
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Fax | 312-277-3735
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Authorized Official
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Title or Position | OWNER
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Name | MANMEET CHATHA
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Credential | OD
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Telephone | 703-961-9119
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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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