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General NPI Number Information
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NPI Number | 1437175684
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Entity Type | Organization
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Legal Business Name | WASHINGTON NATIONAL EYE CENTER
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 110 IRVING STREET, NW SUITE 1A-19
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City | WASHINGTON
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State | DC
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Zip | 20010-2976
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Country | US
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Telephone | 202-877-5329
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Fax | 202-877-7743
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Provider Business Mailing Address
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Address Line | 110 IRVING STREET, NW SUITE 1A-19
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City | WASHINGTON
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State | DC
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Zip | 20010-2976
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Country | US
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Telephone | 202-877-5329
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Fax | 202-877-7743
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Authorized Official
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Title or Position | CHAIRMAN AND PRESIDENT
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Name | DR. JAY M LUSTBADER
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Credential | MD
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Telephone | 202-877-5329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 52132XXXX-53004998
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 52132XXXX53004998
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License Number State | DC
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