MEDICARE: EDENEYECARE LLC

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	261QM1300X	Multi-Specialty Clinic/Center	VA0618000709	VA

General Provider Information

NPI Number	:	1568901288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDENEYECARE LLC

Provider Business Mailing Address
First Line	:	4018 CAMPBELL AVE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3424
Country	:	US
Telephone Number	:	703-671-1188
Fax Number	:	703-671-1198

Provider Business Practice Location Address
First Line	:	4018 CAMPBELL AVE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3424
Country	:	US
Telephone Number	:	703-671-1188
Fax Number	:	703-671-1198

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TERRI H VO
Credential	:	OD
Telephone Number	:	703-671-1188

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	02/14/2017

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