Organization
NORTHERN VIRGINIA EYE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE SISKO (CREDENTIALING SPECIALIST)
(727) 483-7463
Entity
Organization
Contact information
Practice address
212 LINDEN DR, SUITE 154, WINCHESTER, VA 22601-2894
(540) 313-4435
(540) 313-4438
Mailing address
311 PARK PLACE BLVD, CLEARWATER, FL 33759-4904
(727) 483-7463
(727) 755-0679
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101237120
VA
Other
Enumeration date
08/10/2015
Last updated
08/10/2015
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