MEDICARE: TYSONS OPTICAL, 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	332H00000X	Eyewear Supplier	736368	VA

General Provider Information

NPI Number	:	1275653495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYSONS OPTICAL, INC.

Provider Business Mailing Address
First Line	:	1880 HOWARD AVE STE 301B
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2611
Country	:	US
Telephone Number	:	703-761-9504
Fax Number	:	703-761-9542

Provider Business Practice Location Address
First Line	:	8025 TYSONS CORNER CTR
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22102-4505
Country	:	US
Telephone Number	:	703-734-0977
Fax Number	:	703-893-7134

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. ANA D PUHL
Credential	:
Telephone Number	:	703-734-0799

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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