Organization
FAIRFAX EYE ASSOCIATES INC
Active
Organization
FAIRFAX EYE ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERTAD MANGUIKIAN MD (OWNER)
(703) 591-4884
Entity
Organization
Contact information
Practice address
9936 MAIN ST, FAIRFAX, VA 22031
(703) 591-4884
(703) 591-6932
Mailing address
9936 MAIN ST, FAIRFAX, VA 22031
(703) 591-4884
(703) 591-6932
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101024017
VA
207W00000X
Ophthalmology Physician
0101051247
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6343643
—
VA
Enumeration date
03/17/2006
Last updated
08/22/2020
Update your record
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