Organization
POTOMAC EYE CENTER
Active
Organization
POTOMAC EYE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS JAMES FRASER JR. M.D. (PRESIDENT)
(703) 256-2474
Entity
Organization
Contact information
Practice address
5411A BACKLICK RD, SPRINGFIELD, VA 22151-3915
(703) 256-2474
(703) 941-7938
Mailing address
5411A BACKLICK RD, SPRINGFIELD, VA 22151-3915
(703) 256-2474
(703) 941-7938
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101023876
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08 00148
UNITED HEALTH CARE PROV
—
01
—
16820001
CARE FIRST BCBS PROV NO
—
01
—
2146733
MDIPA PROVIDER NUMBER
—
01
—
244846
NCPPO PROVIDER NUMBER
—
01
—
274557
ANTHEM PROVIDER NUMBER
VA
01
—
698420
FIRST HEALTH PROV NUMBER
—
01
—
78521
AETNA PROVIDER ID NUMBER
—
Enumeration date
03/22/2007
Last updated
08/22/2020
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