Basic Information
Provider Information | |||||||||
NPI: | 1083055693 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ORVIN | ||||||||
FirstName: | DEANA | ||||||||
MiddleName: | SATAR | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | OD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SATAR | ||||||||
OtherFirstName: | DEANA | ||||||||
OtherMiddleName: | SYLVIA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1950 OLD GALLOWS RD STE 500 | ||||||||
Address2: |   | ||||||||
City: | VIENNA | ||||||||
State: | VA | ||||||||
PostalCode: | 221823970 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7038478899 | ||||||||
FaxNumber: | 5712236780 | ||||||||
Practice Location | |||||||||
Address1: | 472 W POPLAR AVE STE 102 | ||||||||
Address2: |   | ||||||||
City: | COLLIERVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 380172595 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9013298055 | ||||||||
FaxNumber: | 9012340133 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2013 | ||||||||
LastUpdateDate: | 10/19/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/19/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1772 | SC | N |   | Eye and Vision Services Providers | Optometrist |   | 152W00000X | 3602 | TN | Y |   | Eye and Vision Services Providers | Optometrist |   |
No ID Information.