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General NPI Number Information
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NPI Number | 1528554664
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Entity Type | Individual
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Provider Name | MARIA ISABELLA ORTEGA ROMA OD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 8359 LEESBURG PIKE
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City | VIENNA
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State | VA
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Zip | 22182-2492
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Country | US
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Telephone | 703-442-9295
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Fax |
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Provider Business Mailing Address
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Address Line | 18002 GOLDEN SPRING CT
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City | OLNEY
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State | MD
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Zip | 20832-1773
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Country | US
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Telephone | 202-384-5901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0618002670
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License Number State | VA
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