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General NPI Number Information
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NPI Number | 1538265145
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Entity Type | Organization
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Legal Business Name | JING GUO, O.D. P.C.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3690D KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1921
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Country | US
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Telephone | 703-931-2954
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 LEESBURG PIKE
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City | VIENNA
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State | VA
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Zip | 22182-2409
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Country | US
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Telephone | 703-883-0738
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Fax | 703-883-0789
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JING GUO
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Credential | O.D.
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Telephone | 70398830738
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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 | OP1000013
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000958
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License Number State | VA
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