Basic Information
| Provider Information | |||||||||
| NPI: | 1467782383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HJELMGREN MCCARTHY | ||||||||
| FirstName: | CHANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| OtherLastName: | HJELMGREN | ||||||||
| OtherFirstName: | CHANDA | ||||||||
| OtherMiddleName: | LEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| 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: | 22000 DULLES RETAIL PLZ | ||||||||
| Address2: | SUITE 168 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201662512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034213322 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2009 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618001402 | VA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC 3803 | FL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OP1000090 | DC | N | Eye and Vision Services Providers | Optometrist |
No ID Information.