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General NPI Number Information
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NPI Number | 1316034945
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Entity Type | Organization
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Legal Business Name | JING GUO, O.D.
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 7340 HERITAGE VILLAGE PLZ SUITE 102
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City | GAINESVILLE
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State | VA
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Zip | 20155-3079
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Country | US
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Telephone | 571-261-4929
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Fax |
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Provider Business Mailing Address
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Address Line | 8703 ESQUIRE CROSSING LN
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City | VIENNA
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State | VA
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Zip | 22180-7088
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Country | US
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Telephone | 571-261-4929
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JING GUO
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Credential | O.D.
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Telephone | 571-261-4929
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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 | 0618000958
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License Number State | VA
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