Provider Demographics
NPI:1952358020
Name:EYE CONSULTANTS OF NORTHERN VIRGINIA, P.C.
Entity type:Organization
Organization Name:EYE CONSULTANTS OF NORTHERN VIRGINIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIENSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-763-0963
Mailing Address - Street 1:8136 OLD KEENE MILL RD STE B300
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1856
Mailing Address - Country:US
Mailing Address - Phone:703-763-0963
Mailing Address - Fax:703-451-6247
Practice Address - Street 1:8136 OLD KEENE MILL RD STE B300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1856
Practice Address - Country:US
Practice Address - Phone:703-451-6111
Practice Address - Fax:703-451-6247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0439317207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010140510Medicaid
VA010139929Medicaid
VA006379613Medicaid
VA006305938Medicaid
VA006305938Medicaid
VA010139929Medicaid
VACI3948Medicare PIN
VA010140510Medicaid