Provider Demographics
NPI:1487236626
Name:SPECTRUM RETINA & OCULAR ONCOLOGY, PLLC
Entity type:Organization
Organization Name:SPECTRUM RETINA & OCULAR ONCOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEEGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:703-643-9328
Mailing Address - Street 1:1420 BEVERLY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3700
Mailing Address - Country:US
Mailing Address - Phone:703-643-9328
Mailing Address - Fax:571-378-2237
Practice Address - Street 1:1420 BEVERLY RD STE 110
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3700
Practice Address - Country:US
Practice Address - Phone:703-643-9328
Practice Address - Fax:571-378-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty