NPIMap

Organization Active NPI

Eyedata - Eye Doctors and Technology Advantage

  • Ophthalmology Physician
  • Falls Church, VA
National Provider Identifier
1013358514
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYEDATA - EYE DOCTORS AND TECHNOLOGY ADVANTAGE
Practice address
410 S Washington St
Falls Church, VA 22046-4412
Phone
(703) 532-0728
NPI assigned
Jul 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gustavo Adolfo Corrales Regalado, M.D.
Title
Director
Phone
(301) 335-5860

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary
Clinic/Center 261Q00000X D0069016 MD
Clinic/Center 261Q00000X MD037754 DC
Clinic/Center 261Q00000X 0101249765 VA

Addresses

Primary practice location

410 S Washington St
Falls Church, VA 22046-4412

Mailing address

410 S Washington St
Falls Church, VA 22046-4412
Phone (703) 532-0728

Other identifiers 1

IdentifierTypeStateIssuer
A400003148OtherMDMEDICARE PROVIDER NUMBER

Other names 1

  • Vision Consultants and Surgeons / MG Optical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140208000106 DC Part B Supplier - Clinic/Group Practice 0244469559 Receives reassigned benefits from 3 practitioners
Practice locations: Falls Church, VA

National Provider Directory

National Provider Directory

Locations

2946 Sleepy Hollow Rd
Lowr
Falls Church, VA 22044
Phone (703) 532-0728

410 S Washington St
Falls Church, VA 22046
Phone (703) 532-0728

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1013358514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 S WASHINGTON ST",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220464412",
            "telephone_number": "703-532-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S WASHINGTON ST",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220464412",
            "telephone_number": "703-532-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEDATA - EYE DOCTORS AND TECHNOLOGY ADVANTAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CORRALES REGALADO",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_middle_name": "ADOLFO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "301-335-5860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MD",
            "license": "D0069016",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "DC",
            "license": "MD037754",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": "0101249765",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "A400003148",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Consultants and Surgeons / MG Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Falls Church, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.