Provider Demographics
NPI:1861733545
Name:VIRGINIA ADULT AND PEDIATRIC OPHTHALMOLOGY, PC
Entity type:Organization
Organization Name:VIRGINIA ADULT AND PEDIATRIC OPHTHALMOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-210-5535
Mailing Address - Street 1:5900 FORT DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2425
Mailing Address - Country:US
Mailing Address - Phone:571-210-5535
Mailing Address - Fax:703-376-8865
Practice Address - Street 1:5900 FORT DR
Practice Address - Street 2:SUITE 301
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2425
Practice Address - Country:US
Practice Address - Phone:571-210-5535
Practice Address - Fax:703-376-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243232207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty