Organization
ALEXANDRIA OPHTHALMIC ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB A CLARK M.D. (PRESIDENT/OWNER)
(703) 548-5588
Entity
Organization
Contact information
Practice address
411 N WASHINGTON ST, ALEXANDRIA, VA 22314-2311
(703) 548-5588
(703) 549-1599
Mailing address
411 N WASHINGTON ST, ALEXANDRIA, VA 22314-2311
(703) 548-5588
(703) 549-1599
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101041044
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180015264
RAILROAD MEDICARE
—
05
—
6375570
—
VA
Enumeration date
03/16/2010
Last updated
03/16/2010
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