Moa Mid-Atlantic Chantilly PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MOA MID-ATLANTIC CHANTILLY PC

Practice address

3910 Centreville Rd Ste 102
Chantilly, VA 20151-3280

Phone

(703) 830-6380

NPI assigned

Jan 28, 2022

Last updated

Jan 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Allen, ODNPI 1467424275

Title

Ceo

Phone

(703) 830-6380

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert M Allen, O.D.

  • Optometrist
  • Ashburn, VA
  • NPI 1467424275
  NPD Authorized official

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

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1467105569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44365 PREMIER PLZ STE 210",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475058",
            "telephone_number": "703-830-6380",
            "fax_number": "703-263-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 CENTREVILLE RD STE 102",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201513280",
            "telephone_number": "703-830-6380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOA MID-ATLANTIC CHANTILLY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-830-6380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mire Health Group
• Mahnoor Mirza
• Kiana Kyle D. Misterio, OTR/L
• Erin Mitchell, NP
• Mercy Mkorombindo, FNP
• Moa Mid-Atlantic LLC
• Daren Moat, PT
• Modaresi & Avin DDS PLLC
• Modi & Associates P.C.
• Orli Elizabeth Modi-Skeath, DPT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.