| Greenbriar Vision Center, Inc | |
|
13029 Lee Jackson Memorial Hwy Fairfax VA 22033-2001 | |
| (703) 322-2020 | |
| (703) 322-1221 |
| Full Name | Greenbriar Vision Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13029 Lee Jackson Memorial Hwy, Fairfax, Virginia |
| Authorized Official Name and Position | Nicholas James Marotta (OPTOMETRIST) |
| Authorized Official Contact | 7033222020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenbriar Vision Center, Inc 13029 Lee Jackson Memorial Hwy Fairfax VA 22033-2001 Ph: (703) 322-2020 | Greenbriar Vision Center, Inc 13029 Lee Jackson Memorial Hwy Fairfax VA 22033-2001 Ph: (703) 322-2020 |
| NPI Number | 1609165653 |
|---|---|
| Provider Enumeration Date | 03/30/2011 |
| Last Update Date | 02/23/2012 |
| Medicare PECOS PAC ID | 1153504014 |
|---|---|
| Medicare Enrollment ID | O20111020000239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609165653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0618000088 (Virginia) | Primary |
| Provider Name | Nicholas J Marotta |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1265569099 PECOS PAC ID: 6507040128 Enrollment ID: I20111020000268 |
| Provider Name | Sandra K Marotta |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1396841979 PECOS PAC ID: 9133303753 Enrollment ID: I20160425000214 |
| Provider Name | Jean C Church |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1730405606 PECOS PAC ID: 9032395025 Enrollment ID: I20180926003348 |
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