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General NPI Number Information
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NPI Number | 1326075862
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Entity Type | Organization
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Legal Business Name | DR RALPH A SWETLOW LTD
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 5653 COLUMBIA PIKE
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City | BAILEYS CROSSROADS
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State | VA
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Zip | 22041-2874
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Country | US
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Telephone | 703-578-3600
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Fax | 703-369-7089
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Provider Business Mailing Address
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Address Line | 5653 COLUMBIA PIKE SUITE 101
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City | BAILEYS CROSSROADS
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State | VA
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Zip | 22041-2872
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Country | US
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Telephone | 703-578-3600
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Fax | 703-369-7089
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER RENNER
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Credential | OD
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Telephone | 703-578-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 0618000112
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License Number State | VA
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