Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618000034 | VA |
NPI | 1003879834 |
---|---|
Provider Name | Dr. Gordon Vincent Culp JR. |
First Address | Vienna, VA 22182-3990 |
Second Address | Ashburn, VA 20147-5920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 25/01/2018 |