Provider Demographics
NPI:1144289661
Name:DULLES EYE ASSOCIATES
Entity type:Organization
Organization Name:DULLES EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABU
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:NASRULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-723-9633
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-723-9633
Mailing Address - Fax:703-723-9772
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:STE 106
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-723-9633
Practice Address - Fax:703-723-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
VA0101232401207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6310532Medicaid
DCG8480001OtherCAREFIRST
DC68480001OtherCAREFIRST
VA14619OtherANTHEM
VA2112890OtherUNITED HEALTH CARE
VAP0004567OtherRAILROAD MEDICARE
VA6310532Medicaid
VA2112890OtherUNITED HEALTH CARE
DCG01049Medicare PIN