MEDICARE: DR. DENNIS ROBERT CANTWELL

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	0618000023	VA

General Provider Information

NPI Number	:	1144308594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS ROBERT CANTWELL

Provider Business Mailing Address
First Line	:	7006 LITTLE RIVER TPKE STE A
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3218
Country	:	US
Telephone Number	:	703-941-3937
Fax Number	:	703-941-4003

Provider Business Practice Location Address
First Line	:	7006 LITTLE RIVER TPKE STE A
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3218
Country	:	US
Telephone Number	:	703-941-3937
Fax Number	:	703-941-4003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	10/18/2011

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