Organization
SOP SONG, OD PC
Active
Other names
GALLERIA OPTICAL
Organization subpart
No
Provider details
NPI number
Authorized official
SOP SONG O.D. (PRESIDENT)
(703) 658-7040
Entity
Organization
Contact information
Practice address
7700 LITTLE RIVER TPKE, SUITE 101, ANNANDALE, VA 22003-2406
(703) 658-7070
(703) 658-7071
Mailing address
7700 LITTLE RIVER TPKE, SUITE 101, ANNANDALE, VA 22003-2406
(703) 658-7070
(703) 658-7071
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000574
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0618000574
STATE BOARD
VA
01
—
TA1227
STATE BOARD
MD
Enumeration date
11/13/2008
Last updated
11/13/2008
Update your record
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