=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457701351
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. NADA CHEDID
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2016
-----------------------------------------------------
Last Update Date | 06/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 TINDER CT
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-8513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-619-5110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 TINDER CT
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-8513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-619-5110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FC0800X
-----------------------------------------------------
Taxonomy Name | Contact Lens Technician/Technologist
-----------------------------------------------------
License Number | 1101003141
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FC0801X
-----------------------------------------------------
Taxonomy Name | Contact Lens Fitter
-----------------------------------------------------
License Number | 1101003141
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 156FX1100X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Technician/Technologist
-----------------------------------------------------
License Number | 1101003141
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 1101003141
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------