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General NPI Number Information
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NPI Number | 1629143946
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Entity Type | Individual
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Provider Name | VICTOR GABRIEL GUEVARA O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 29015 THREE NOTCH RD
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City | MECHANICSVILLE
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State | MD
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Zip | 20659-3228
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Country | US
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Telephone | 301-884-4774
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Fax | 301-884-6000
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Provider Business Mailing Address
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Address Line | 1950 OLD GALLOWS RD STE 520
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City | VIENNA
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State | VA
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Zip | 22182-3970
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Country | US
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Telephone | 703-847-8899
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Fax | 866-795-4020
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TA 1231
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License Number State | MD
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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 | TA1231
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License Number State | MD
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