Provider Demographics
NPI:1063570513
Name:NORTHERN VIRGINIA EYE INSTITUTE
Entity type:Organization
Organization Name:NORTHERN VIRGINIA EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYYIB
Authorized Official - Middle Name:S
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-313-4435
Mailing Address - Street 1:212 LINDEN DR.
Mailing Address - Street 2:#154
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-313-4435
Mailing Address - Fax:540-313-4438
Practice Address - Street 1:212 LINDEN DR.
Practice Address - Street 2:#154
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-313-4435
Practice Address - Fax:540-313-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09274Medicare ID - Type Unspecified