Individual
DR. MITA GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
8912 CENTREVILLE RD, MANASSAS, VA 20110-8455
(703) 361-6151
(703) 361-1750
Mailing address
13109 OAT CT, WOODBRIDGE, VA 22193-7010
(804) 929-6829
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001643
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912977646
—
VA
Enumeration date
01/25/2006
Last updated
12/15/2009
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