MEDICARE: DR. STEVEN REDDING BULLARD MD

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	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician	052853	VA
2	207W00000X	Ophthalmology Physician	052853	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	:	1235115544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN REDDING BULLARD MD

Provider Business Mailing Address
First Line	:	2865 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4512
Country	:	US
Telephone Number	:	703-370-2455
Fax Number	:	703-461-7887

Provider Business Practice Location Address
First Line	:	2865 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4512
Country	:	US
Telephone Number	:	703-370-2455
Fax Number	:	703-461-7887

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	04/22/2020

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