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General NPI Number Information
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NPI Number | 1447501606
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Entity Type | Organization
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Legal Business Name | EYE PRO
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 6530 TRADING SQ
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City | HAYMARKET
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State | VA
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Zip | 20169-2278
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Country | US
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Telephone | 703-754-1113
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Fax | 703-754-1121
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Provider Business Mailing Address
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Address Line | 1604 PONDVIEW DR
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City | WINCHESTER
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State | VA
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Zip | 22601-2853
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Country | US
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Telephone | 703-398-4572
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DANIEL DAVID GOERL
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Credential | OD
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Telephone | 703-754-1113
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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 | 0618000053
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License Number State | VA
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