NPI | 1881663102 |
---|---|
Entity Type | Organization |
Authorized Contact | DERTAD MANGUIKIAN Owner 703-591-4884 |
Organization Subpart ? | No |
Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101024017) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101051247) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2020-08-22 |