Maximeyes Vision Source, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618002092 Issued in VA

Legal business name

MAXIMEYES VISION SOURCE, LLC

Practice address

11011 Lee Hwy
Fairfax, VA 22030-5002

Phone

(703) 691-7584

Fax

(703) 591-6271

NPI assigned

Jun 2, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Maria Pham, OD

Title

Optometrist/Owner

Phone

(703) 691-7584

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1496361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497916800000",
    "number": "1295263234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1390 CHAIN BRIDGE RD # 313",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013904",
            "telephone_number": "703-691-7584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11011 LEE HWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305002",
            "telephone_number": "703-691-7584",
            "fax_number": "703-591-6271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIMEYES VISION SOURCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-02",
        "last_updated": "2017-06-20",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "703-691-7584",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY TPA LICENSE",
            "identifier": "0618002092",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Matyi, PHARMD
• Kimberly Ann Matzie, MD
• Maurice Atiyeh MD
• Lauren A Mauro, M.D.
• Evangelia Mavridou
• Catherine Hurley Maxwell, PA
• Jamison Maxwell, MD
• Joanna Izquierdo May, PA
• Maya Home Health Care LLC
• Anthony Lamar Mayen, MD

• Optometrist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.