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General NPI Number Information
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NPI Number | 1851729974
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Entity Type | Organization
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Legal Business Name | DR. SURMATY AND ASSOCIATES THE VISION CENTER LLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 400 SPOTSYLVANIA MALL
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-1123
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Country | US
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Telephone | 540-785-2763
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Fax |
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Provider Business Mailing Address
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Address Line | 6416 WHIPPANY WAY
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City | BURKE
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State | VA
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Zip | 22015-3427
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Country | US
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Telephone | 571-340-5523
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | AIATULAH SURMATY
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Credential | O.D.
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Telephone | 571-340-5523
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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 | 0618002282
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License Number State | VA
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