MEDICARE: CRYSTAL EYE CARE,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618000794	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083637466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL EYE CARE,INC

Provider Business Mailing Address
First Line	:	1654 CRYSTAL SQUARE ARC
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-3322
Country	:	US
Telephone Number	:	703-413-9001
Fax Number	:	703-552-1334

Provider Business Practice Location Address
First Line	:	1654 CRYSTAL SQUARE ARC
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-3322
Country	:	US
Telephone Number	:	703-413-9001
Fax Number	:	703-552-1334

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFF C. CHUH
Credential	:	O.D.
Telephone Number	:	703-413-9001

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/28/2013

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