Northern Virginia Vision Center, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618-000230 Issued in VA

Legal business name

NORTHERN VIRGINIA VISION CENTER, INC.

Practice address

21475 Ridgetop Circle
Suite 300
Sterling, VA 20166-6580

Phone

(703) 430-4400

Fax

(703) 430-4130

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Ayman Boutros, M.D.NPI 1366530131

Title

President/Owner

Phone

(703) 430-4400

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• The Eye Center Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ayman Boutros, M.D.

  • Ophthalmology Physician
  • Sterling, VA
  • NPI 1366530131
  Medicare reassignment Authorized official
• Chanpreet Kataria

  • Optometrist
  • Sterling, VA
  • NPI 1922615103
  Medicare reassignment NPD
• Alvin Siv

  • Optometrist
  • Alexandria, VA
  • NPI 1356894869
  Medicare reassignment NPD
• Dian Yu, M.D.

  • Ophthalmology Physician
  • Sterling, VA
  • NPI 1639527682
  Medicare reassignment NPD
• Christina L. Butera, M.D.

  • Ophthalmology Physician
  • Sterling, VA
  • NPI 1366523102
  Medicare reassignment
• Houriya Mahboobi, O.D.

  • Optometrist
  • Sterling, VA
  • NPI 1013323500
  Medicare reassignment
• Aryan Mashid, OD

  • Optometrist
  • Sterling, VA
  • NPI 1902274574
  Medicare reassignment
• Russell B. Pearlman, O.D.

  • Optometrist
  • Sterling, VA
  • NPI 1013098748
  Medicare reassignment
• Renata B. Raeder, O.D.

  • Optometrist
  • Sterling, VA
  • NPI 1699857003
  Medicare reassignment
• Darrell Steven Reisner, M.D.

  • Ophthalmology Physician
  • Sterling, VA
  • NPI 1912095019
  Medicare reassignment
• Deena Tailor, OD

  • Optometrist
  • Sterling, VA
  • NPI 1104356815
  Medicare reassignment
• Nicole G. Teser, O.D.

  • Optometrist
  • Sterling, VA
  • NPI 1316029739
  Medicare reassignment

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1710069950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21475 RIDGETOP CIR",
            "address_2": "SUITE 300",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201666580",
            "telephone_number": "703-430-4400",
            "fax_number": "703-430-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21475 RIDGETOP CIRCLE",
            "address_2": "SUITE 300",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201666580",
            "telephone_number": "703-430-4400",
            "fax_number": "703-430-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN VIRGINIA VISION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "BOUTROS",
        "authorized_official_first_name": "AYMAN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "703-430-4400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618-000230",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101-043806",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEMERC STERLING OFFICE",
            "identifier": "0858550001",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NCA/CAPITAL CARE",
            "identifier": "4147",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEMERC FAIRFAX OFFICE",
            "identifier": "0858550003",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEMERC ALEXANDRIA OFFICE",
            "identifier": "0858550002",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEMERC LEESBURG OFFICE",
            "identifier": "0858550004",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8956502",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.