Provider Demographics
NPI:1528296456
Name:GOREN, CRAIG BRAD (OD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:BRAD
Last Name:GOREN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:617 POTOMAC STATION DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1817
Practice Address - Country:US
Practice Address - Phone:703-669-4646
Practice Address - Fax:703-991-0514
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist