Provider Demographics
NPI:1528241965
Name:DULLES EYE ASSOCIATES
Entity type:Organization
Organization Name:DULLES EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-723-9633
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-723-9633
Mailing Address - Fax:703-723-9772
Practice Address - Street 1:3301 WOODBURN RD STE 204
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7302
Practice Address - Country:US
Practice Address - Phone:703-208-3299
Practice Address - Fax:703-208-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232401207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112890OtherUNITEDHEALTH CARE
DCG8480001OtherCAREFIRST
VA14619OtherANTHEM
VA006310532Medicaid
A46705Medicare UPIN
VAC08609Medicare PIN
VAP0004567Medicare PIN