Basic Information
| Provider Information | |||||||||
| NPI: | 1275821910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAILOR | ||||||||
| FirstName: | BINITA | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 7039910514 | ||||||||
| Practice Location | |||||||||
| Address1: | 20940 FREDERICK RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208764103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403619600 | ||||||||
| FaxNumber: | 2403619605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 07/15/2011 | ||||||||
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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 | 152W00000X | 0618002062 | VA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | TA2264 | MD | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.