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NPI Code Detail

MEDICARE: SAMANTHA DOUGHERTY O. D.

MEDICARE: SAMANTHA DOUGHERTY O. D.
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
1152W00000XOptometristOEG003391PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OEG003391OTHERPAPENNSYLVANIA OPTOMETRY LICENSE

General Provider Information

NPI Number : 1740662741
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DOUGHERTY O. D.
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number :
Provider Business Practice Location Address
First Line : 2316 MEETINGHOUSE RD
Second Line :
City : UPPER CHICHESTER
State : PA
Zip : 19061-3438
Country : US
Telephone Number : 610-485-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2015
Last Update Date : 05/19/2023

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