Provider Demographics
NPI:1194976969
Name:MY VISION CARE PLLC
Entity type:Organization
Organization Name:MY VISION CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHFAQ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-878-2020
Mailing Address - Street 1:14599 CHARITY CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1200
Mailing Address - Country:US
Mailing Address - Phone:703-878-2020
Mailing Address - Fax:703-878-2020
Practice Address - Street 1:14130 NOBLEWOOD PLZ
Practice Address - Street 2:UNIT 105
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1464
Practice Address - Country:US
Practice Address - Phone:703-878-2020
Practice Address - Fax:703-878-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194976969Medicaid
VA363065OtherANTHEM BCBS
VA1194976969Medicaid