Provider Demographics
NPI:1538265145
Name:JING GUO, O.D. P.C.
Entity type:Organization
Organization Name:JING GUO, O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:7039-883-0738
Mailing Address - Street 1:8500 LEESBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2409
Mailing Address - Country:US
Mailing Address - Phone:703-883-0738
Mailing Address - Fax:703-883-0789
Practice Address - Street 1:3690D KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1921
Practice Address - Country:US
Practice Address - Phone:703-931-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP1000013152W00000X
VA0618000958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty