Organization
EYE PLASTIC ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LUNDMARK (OFFICE MANAGER)
(703) 620-4300
Entity
Organization
Contact information
Practice address
3700 JOSEPH SIEWICK DR, SUITE 400, FAIRFAX, VA 22033-1744
(703) 620-4300
(703) 620-4367
Mailing address
3700 JOSEPH SIEWICK DR, SUITE 400, FAIRFAX, VA 22033-1744
(703) 620-4300
(703) 620-4367
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101047
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006305245
—
VA
Enumeration date
08/01/2007
Last updated
02/25/2010
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