=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902036437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUDNER & ASSOCIATES O.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2009
-----------------------------------------------------
Last Update Date | 10/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4084 UNIVERSITY DR 204
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-6803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-691-8008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4084 UNIVERSITY DR 204
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-6803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-691-8008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HOWARD D BUDNER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 703-691-8008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | VA1108
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------