Provider Demographics
NPI:1063578524
Name:STAFFORD OPTOMETRY, LLC
Entity type:Organization
Organization Name:STAFFORD OPTOMETRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-847-8899
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1515 STAFFORD MARKET PL
Practice Address - Street 2:STE. 121
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4531
Practice Address - Country:US
Practice Address - Phone:540-657-2020
Practice Address - Fax:540-657-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
VA0618001573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6043200001OtherDMERC