Provider Demographics
NPI:1427102763
Name:EYE PHYSICIANS OF VIRGINIA, LTD.
Entity type:Organization
Organization Name:EYE PHYSICIANS OF VIRGINIA, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-437-3900
Mailing Address - Street 1:6845 ELM ST STE 611
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3843
Mailing Address - Country:US
Mailing Address - Phone:703-356-6880
Mailing Address - Fax:703-893-7336
Practice Address - Street 1:1800 TOWN CENTER DR STE 317
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3239
Practice Address - Country:US
Practice Address - Phone:703-437-3900
Practice Address - Fax:703-437-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037922207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC743091OtherDC MEDICARE GRP
VAC14195OtherRAIL ROAD MEDICARE