Provider Demographics
NPI:1285721431
Name:DOMINION EYE CARE, P.C.
Entity type:Organization
Organization Name:DOMINION EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELICIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-361-3128
Mailing Address - Street 1:8140 ASHTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5699
Mailing Address - Country:US
Mailing Address - Phone:703-361-3128
Mailing Address - Fax:703-361-3670
Practice Address - Street 1:8140 ASHTON AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:703-361-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOMINION EYE CARE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA099706OtherBCBS OF VA ANTHEM GRP
VACG4422OtherRR MEDICARE PIN
VACG4422OtherRAIL ROAD MEDICARE GRP
VAC01662OtherTRAILBLAZER MEDICARE GRP
VA0757379OtherCIGNA GROUP
VA099706OtherBCBS OF VA ANTHEM GRP