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General NPI Number Information
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NPI Number | 1508259128
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Entity Type | Organization
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Legal Business Name | VISIONARY INCORPORATED OF VIRGINIA II
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 7944L TYSONS CORNER CTR
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City | MC LEAN
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State | VA
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Zip | 22102-4500
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Country | US
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Telephone | 703-288-0011
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Fax | 703-288-0044
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Provider Business Mailing Address
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Address Line | 7944L TYSONS CORNER CTR
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City | MC LEAN
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State | VA
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Zip | 22102-4500
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Country | US
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Telephone | 703-288-0011
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Fax | 703-288-0044
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANN LOFTUS POLONCAK
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Credential | O.D.
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Telephone | 703-288-0011
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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 | 0618002301
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License Number State | VA
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