Basic Information
| Provider Information | |||||||||
| NPI: | 1609322320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOOK | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 S BELL ST | ||||||||
| Address2: | STE C1819 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222023559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 8667954020 | ||||||||
| Practice Location | |||||||||
| Address1: | 1632A BELLE VIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223076531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036649494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046011051 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OP1000363 | DC | N | Eye and Vision Services Providers | Optometrist | 152W00000X | TA2580 | MD | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618002592 | VA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.