Basic Information
| Provider Information | |||||||||
| NPI: | 1033302708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE EYECARE CENTER OPTOMETRISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13320 FRANKLIN FARM RD STE H | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201714097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034815600 | ||||||||
| FaxNumber: | 7034374137 | ||||||||
| Practice Location | |||||||||
| Address1: | 13320 FRANKLIN FARM RD STE H | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201714097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034815600 | ||||||||
| FaxNumber: | 7034374137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2007 | ||||||||
| LastUpdateDate: | 08/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | COCHRAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7034815600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0603000413 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.