Neil Magee Bleakley, OD
Individual provider Active NPI Optometrist · Dulles, VA
NPI 1114007408 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1114007408
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 0601000747 (VA)
- Practice address
- Dulles Town Center Mall
#290
Dulles, VA 20166 - Phone
- (703) 421-3438
- Fax
- (703) 421-3428
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0601000747 | VA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dulles Town Center Optical, Inc | Past | Accepting new patients | |
| Dulles Town Center Optics | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0601000747 | VA | Yes |
Addresses
Primary practice location
Dulles Town Center Mall
#290
Dulles, VA 20166
Mailing address
39155 Aldie Rd
Aldie, VA 20105-2005
Phone (703) 421-3438
Other providers in Dulles, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.