Provider Demographics
NPI:1447467881
Name:DR. VOORTHUIS, O.D. AND ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DR. VOORTHUIS, O.D. AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:CORINNE
Authorized Official - Last Name:VOORTHUIS-GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-683-3822
Mailing Address - Street 1:3301 NEW MEXICO AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3622
Mailing Address - Country:US
Mailing Address - Phone:202-363-5087
Mailing Address - Fax:202-363-5063
Practice Address - Street 1:530 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3104
Practice Address - Country:US
Practice Address - Phone:703-683-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06018000927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty