Basic Information
| Provider Information | |||||||||
| NPI: | 1033160403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 8667954020 | ||||||||
| Practice Location | |||||||||
| Address1: | 2184 HENDERSON MILL RD NE | ||||||||
| Address2: | 12B | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303453762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709382923 | ||||||||
| FaxNumber: | 7709382943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 02/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OPT000870 | GA | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | OPT000870 | GA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 581439323 | 01 | GA | AETNA | OTHER | 581439323 | 01 | GA | VISION CARE PLAN | OTHER | 581439323 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER | 581439323 | 01 | GA | AVESIS | OTHER | 581439323 | 01 | GA | FIRST HEALTH | OTHER | 581439323 | 01 | GA | CIGNA | OTHER | 581439323 | 01 | GA | UNICARE | OTHER | 581439323 | 01 | GA | PHCS | OTHER | 581439323 | 01 | GA | TRICARE | OTHER | GA0870 | 01 | GA | EYEMED VISION | OTHER | 000473118A | 05 | GA | MEDICAID | 581439323 | 01 | GA | VISION SERVICE PLAN | OTHER |