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General NPI Number Information
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NPI Number | 1528378544
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Entity Type | Organization
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Legal Business Name | EDEN EYECARE LLC
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 6795 WILSON BLVD STE 24
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City | FALLS CHURCH
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State | VA
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Zip | 22044-3313
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Country | US
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Telephone | 703-237-2020
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Fax | 703-237-8788
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Provider Business Mailing Address
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Address Line | 6795 WILSON BLVD STE 24
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City | FALLS CHURCH
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State | VA
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Zip | 22044-3313
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Country | US
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Telephone | 703-237-2020
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Fax | 703-237-8788
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. TERRI H VO
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Credential | O.D.
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Telephone | 703-237-2020
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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 | 0618000709
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License Number State | VA
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