=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982835021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUTARIA EYE CARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2009
-----------------------------------------------------
Last Update Date | 08/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42395 RYAN RD SUITE 120
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20148-4863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-203-9656
-----------------------------------------------------
Fax | 703-203-9656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3600 S GLEBE RD 227
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22202-2365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-203-9656
-----------------------------------------------------
Fax | 703-203-9656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. MEERA SUTARIA
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 703-203-9656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0618001658
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------