Active NPI
Scott Song, OD
- Optometrist
- Chantilly, VA
National Provider Identifier
1710178462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0618001652
- Practice address
- 14390 Chantilly Crossing LN
Chantilly, VA 20151-2117 - Phone
- (703) 263-7970
- Fax
- (703) 263-7970
- NPI assigned
- Aug 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618001652 | VA | Primary |
Addresses
Primary practice location
14390 Chantilly Crossing LN
Chantilly, VA 20151-2117
Mailing address
14390 Chantilly Crossing LN
Chantilly, VA 20151-2117
Phone (703) 263-7970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080109000351 | DC | Practitioner - Optometry | 3870673395 | Practice locations: Fairfax, VA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753401600000",
"number": "1710178462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14390 CHANTILLY CROSSING LN",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201512117",
"telephone_number": "703-263-7970",
"fax_number": "703-263-7970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14390 CHANTILLY CROSSING LN",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201512117",
"telephone_number": "703-263-7970",
"fax_number": "703-263-7970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "SCOTT",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-07",
"last_updated": "2025-07-25",
"certification_date": "2025-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618001652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chantilly, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.