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General NPI Number Information
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NPI Number | 1902284862
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Entity Type | Organization
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Legal Business Name | SYEDA KUTUB, PC
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 5901 DUKE ST
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3211
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Country | US
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Telephone | 703-914-2144
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Fax | 703-354-4124
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Provider Business Mailing Address
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Address Line | 5901 DUKE ST
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3211
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Country | US
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Telephone | 703-914-2144
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Fax | 703-354-4124
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SYEDA KUTUB
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Credential | O.D.
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Telephone | 703-914-2144
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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 | 0618002340
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License Number State | VA
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