Organization
EYEDATA - EYE DOCTORS AND TECHNOLOGY ADVANTAGE
Active
Organization
EYEDATA - EYE DOCTORS AND TECHNOLOGY ADVANTAGE
Active
Other names
Vision Consultants and Surgeons / MG Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUSTAVO ADOLFO CORRALES REGALADO M.D. (DIRECTOR)
(301) 335-5860
Entity
Organization
Contact information
Practice address
410 S WASHINGTON ST, FALLS CHURCH, VA 22046-4412
(703) 532-0728
Mailing address
410 S WASHINGTON ST, FALLS CHURCH, VA 22046-4412
(703) 532-0728
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
261Q00000X
Clinic/Center
0101249765
VA
261Q00000X
Clinic/Center
D0069016
MD
261Q00000X
Clinic/Center
MD037754
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A400003148
MEDICARE PROVIDER NUMBER
MD
Enumeration date
07/12/2013
Last updated
07/21/2022
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