| 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 |