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General NPI Number Information
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NPI Number | 1689008146
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Entity Type | Organization
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Legal Business Name | RETINA SPECIALISTS OF VIRGINIA PLC
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Dates
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Enumeration Date | 09/02/2013
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Last Update Date | 09/02/2013
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Provider Practice Location Address
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Address Line | 2200 N WESTMORELAND ST UNIT 316
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City | ARLINGTON
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State | VA
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Zip | 22213-1044
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Country | US
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Telephone | 703-543-9808
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 N WESTMORELAND ST UNIT 316
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City | ARLINGTON
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State | VA
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Zip | 22213-1044
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Country | US
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Telephone | 703-543-9808
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DARYL EDWARD KURZ
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Credential | MD
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Telephone | 703-543-9808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101251878
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License Number State | VA
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