Organization
CRESTWOOD OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC W KELLER OPTICIAN (OWNER)
(703) 369-1616
Entity
Organization
Contact information
Practice address
8078 SUDLEY RD, MANASSAS, VA 20109
(703) 369-1616
(703) 369-7902
Mailing address
8078 SUDLEY RD, MANASSAS, VA 20109
(703) 369-1616
(703) 369-7902
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
967
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9282831
—
VA
Enumeration date
07/16/2006
Last updated
06/20/2008
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