Organization Active NPI

Steven R. Bullard, M.D., P.C.

  • Ophthalmology Physician
  • Alexandria, VA
National Provider Identifier
1336350552
Registry record updated Sep 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
0101052853 Issued in VA
Legal business name
STEVEN R. BULLARD, M.D., P.C.
Practice address
2865 Duke St
Alexandria, VA 22314-4512
Phone
(703) 370-2455
Fax
(703) 461-7887
NPI assigned
May 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2010

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

Authorized official

Name
Steven Redding Bullard, M.D.NPI 1235115544
Title
President
Phone
(703) 370-2455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 0101052853 VA Primary

Addresses

Primary practice location

2865 Duke St
Alexandria, VA 22314-4512

Mailing address

2865 Duke St
Alexandria, VA 22314-4512
Phone (703) 370-2455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071022000541 DC Part B Supplier - Clinic/Group Practice 5890881833 Receives reassigned benefits from 1 practitioner
Practice locations: Alexandria, VA; Ashburn, VA; Burke, VA; Fairfax, VA; Reston, VA
O20080715000344 VA Part B Supplier - Clinic/Group Practice 5890881833 Receives reassigned benefits from 1 practitioner
Practice locations: Ashburn, VA

National Provider Directory

National Provider Directory

Locations

44121 Leesburg Pike
Ste 205
Ashburn, VA 20147
Phone (703) 370-2455

5204A Rolling Rd
Burke, VA 22015
Phone (703) 425-2000

3020 Hamaker Ct
Ste B103
Fairfax, VA 22031
Phone (703) 370-2455

Practitioners & affiliated clinicians

Practitioners 1

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": "1180310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284336000000",
    "number": "1336350552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 DUKE ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223144512",
            "telephone_number": "703-370-2455",
            "fax_number": "703-461-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 DUKE ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223144512",
            "telephone_number": "703-370-2455",
            "fax_number": "703-461-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVEN R. BULLARD, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-28",
        "last_updated": "2010-09-13",
        "status": "A",
        "authorized_official_last_name": "BULLARD",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "REDDING",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-370-2455",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101052853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; 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.