Provider Demographics
NPI:1386760247
Name:POTOMAC EYE CENTER
Entity type:Organization
Organization Name:POTOMAC EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-256-2474
Mailing Address - Street 1:5411A BACKLICK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3915
Mailing Address - Country:US
Mailing Address - Phone:703-256-2474
Mailing Address - Fax:703-941-7938
Practice Address - Street 1:5411A BACKLICK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3915
Practice Address - Country:US
Practice Address - Phone:703-256-2474
Practice Address - Fax:703-941-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023876207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
244846OtherNCPPO PROVIDER NUMBER
78521OtherAETNA PROVIDER ID NUMBER
2146733OtherMDIPA PROVIDER NUMBER
2146733OtherONENETALLIANCE PROV NO
08 00148OtherUNITED HEALTH CARE PROV
16820001OtherCARE FIRST BCBS PROV NO
698420OtherFIRST HEALTH PROV NUMBER
16820001OtherBCBS NATL CAPITAL PROV NO
2146733OtherMAMSI PROVIDER NUMBER
2146733OtherOPTIMUM CHOICE PROV NO
VA274557OtherANTHEM PROVIDER NUMBER
VAC62501Medicare UPIN
DC405460Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER