Active NPI
Vickie Fang, O.D.
- Optometrist
- Gaithersburg, MD
National Provider Identifier
1083878417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- DA1359
- Practice address
- 880 Russell Ave
Gaithersburg, MD 20879-3506 - Phone
- (301) 556-1973
- Fax
- (301) 556-1968
- NPI assigned
- Jul 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | DA1359 | MD | Primary |
Addresses
Primary practice location
880 Russell Ave
Gaithersburg, MD 20879-3506
Mailing address
880 Russell Ave
Gaithersburg, MD 20879-3506
Phone (301) 556-1973
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DA1359 | MD | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216080000000",
"number": "1083878417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "880 RUSSELL AVE",
"city": "GAITHERSBURG",
"state": "MD",
"postal_code": "208793506",
"telephone_number": "301-556-1973",
"fax_number": "301-556-1968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "880 RUSSELL AVE",
"city": "GAITHERSBURG",
"state": "MD",
"postal_code": "208793506",
"telephone_number": "301-556-1973",
"fax_number": "301-556-1968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANG",
"first_name": "VICKIE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-15",
"last_updated": "2008-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "DA1359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gaithersburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.