MEDICARE: EYE2EYE OPTOMETRY CORNER, PC

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	0618000936	VA

General Provider Information

NPI Number	:	1275753055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE2EYE OPTOMETRY CORNER, PC

Provider Business Mailing Address
First Line	:	1502 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1718
Country	:	US
Telephone Number	:	703-548-0122
Fax Number	:	703-548-0133

Provider Business Practice Location Address
First Line	:	1502 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1718
Country	:	US
Telephone Number	:	703-548-0122
Fax Number	:	703-548-0133

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DORA ADAMOPOULOS
Credential	:	O.D.
Telephone Number	:	703-548-0122

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/01/2014

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