Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618001835 | VA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 0618001835 | VA |
N | 152WP0200X | Pediatric Optomitrist | 0618001835 | VA |
N | 152WS0006X | Sports Vision | 0618001835 | VA |
N | 152WV0400X | Optomitrist - Vision Therapist | 0618001835 | VA |
N | 152WX0102X | Occupational Vision | 0618001835 | VA |
NPI | 1164543609 |
---|---|
Provider Name | Joseph V. Otto |
First Address | Manassas, VA 20109-2629 |
Second Address | Manassas, VA 20109-2629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 29/05/2010 |