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General NPI Number Information
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NPI Number | 1407079155
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA EYE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 2710 PROSPERITY AVE SUITE 150
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City | FAIRFAX
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State | VA
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Zip | 22031-4320
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Country | US
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Telephone | 703-289-1290
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Fax | 703-289-1298
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Provider Business Mailing Address
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Address Line | 2710 PROSPERITY AVE SUITE 150
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City | FAIRFAX
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State | VA
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Zip | 22031-4320
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Country | US
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Telephone | 703-289-1290
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Fax | 703-289-1298
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WILLIAM RICH III
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Credential | M.D.
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Telephone | 703-534-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OH712
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License Number State | VA
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