Provider Demographics
NPI:1871631770
Name:DRSTHELEN PC
Entity type:Organization
Organization Name:DRSTHELEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COURT
Authorized Official - Middle Name:D
Authorized Official - Last Name:THELEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-941-4111
Mailing Address - Street 1:7540 LITTLE RIVER TPKE STE B
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2839
Mailing Address - Country:US
Mailing Address - Phone:703-941-4111
Mailing Address - Fax:703-941-3929
Practice Address - Street 1:7630 LITTLE RIVER TPKE STE 100
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2614
Practice Address - Country:US
Practice Address - Phone:703-941-4111
Practice Address - Fax:703-941-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0603000369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty