Provider Demographics
NPI:1194982819
Name:POTOMAC OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:POTOMAC OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:O'DEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-580-5348
Mailing Address - Street 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-580-5348
Mailing Address - Fax:703-590-2288
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-580-5348
Practice Address - Fax:703-590-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty