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General NPI Number Information
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NPI Number | 1396450300
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Entity Type | Organization
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Legal Business Name | NEW VISION FAMILY EYE CLINIC LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 420 MADISON TRADE PLZ SE
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City | LEESBURG
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State | VA
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Zip | 20175-3761
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Country | US
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Telephone | 240-636-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 23936 MILL WHEEL PL
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City | ALDIE
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State | VA
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Zip | 20105-4006
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Country | US
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Telephone | 240-636-1515
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | MARJAN TOFIGH
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Credential | OD
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Telephone | 240-636-1515
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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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