Provider Demographics
NPI:1174531156
Name:MICHAEL O. HUGHES
Entity type:Organization
Organization Name:MICHAEL O. HUGHES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:703-352-3520
Mailing Address - Street 1:307 MAPLE AVE W
Mailing Address - Street 2:#B
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-352-3520
Mailing Address - Fax:703-938-2905
Practice Address - Street 1:307 MAPLE AVE W
Practice Address - Street 2:#B
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-352-3520
Practice Address - Fax:703-938-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034648900Medicaid
VA009134531Medicaid
MD699440700Medicaid
0803890001Medicare ID - Type Unspecified