Basic Information
Provider Information
NPI: 1245231455
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEEL
FirstName: GEORGE
MiddleName: MORRIS
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1950 OLD GALLOWS RD STE 520
Address2:  
City: VIENNA
State: VA
PostalCode: 221823970
CountryCode: US
TelephoneNumber: 7038478899
FaxNumber: 5712236780
Practice Location
Address1: 8329 WHITLEY RD
Address2:  
City: WATAUGA
State: TX
PostalCode: 761482483
CountryCode: US
TelephoneNumber: 8174312020
FaxNumber: 8174316680
Other Information
ProviderEnumerationDate: 08/10/2005
LastUpdateDate: 02/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152WC0802X02354TGTXN Eye and Vision Services ProvidersOptometristCorneal and Contact Management
152W00000X2354TGTXY193400000X SINGLE SPECIALTY GROUPEye and Vision Services ProvidersOptometrist 

No ID Information.


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