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General NPI Number Information
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NPI Number | 1629276779
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Entity Type | Organization
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Legal Business Name | 20-20 OPTOMETRISTS P.C.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 7013 BRADDOCK MEWS PL
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3502
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Country | US
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Telephone | 703-642-2432
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Fax | 703-642-2432
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Provider Business Mailing Address
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Address Line | 7013 BRADDOCK MEWS PL
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3502
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Country | US
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Telephone | 703-642-2432
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Fax | 703-642-2432
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CONSTANTINE JAMES DUSCKAS
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Credential | O.D.
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Telephone | 703-642-2432
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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 | 0618-000492
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License Number State | VA
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