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General NPI Number Information
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NPI Number | 1407230774
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Entity Type | Individual
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Provider Name | DUSTIN COLT BRISCOE O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 14465 POTOMAC MILLS RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6807
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Country | US
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Telephone | 703-494-6184
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Fax | 703-499-9744
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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Fax | 571-223-6780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901005020
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3186
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG004046
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | NA2947
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618003275
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License Number State | VA
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