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General NPI Number Information
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NPI Number | 1801691183
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Entity Type | Organization
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Legal Business Name | AEG WASHINGTON DC PROFESSIONAL PLLC
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 919 18TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20006-5503
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Country | US
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Telephone | 202-467-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E 4TH ST STE 440
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City | ALTON
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State | IL
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Zip | 62002-6206
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Country | US
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Telephone | 314-741-8183
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Fax |
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Authorized Official
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Title or Position | SR. DIRECTOR MVC
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Name | MELISSA ALLISON
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Credential |
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Telephone | 314-741-8183
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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 |
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License Number State |
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