Fairfax Eye Associates Inc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

0101024017 Issued in VA

Legal business name

FAIRFAX EYE ASSOCIATES INC

Practice address

9936 Main St
Fairfax, VA 22031

Phone

(703) 591-4884

Fax

(703) 591-6932

NPI assigned

Mar 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Dertad Manguikian, MD

Title

Owner

Phone

(703) 591-4884

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 2

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

• Alex Dertad Manguikian, M.D., PH.D.

  • Ophthalmology Physician
  • Fairfax, VA
  • NPI 1164657342

  DC

  Medicare reassignment
• John Phillip Essepian III, M.D.

  • Ophthalmology Physician
  • Fairfax, VA
  • NPI 1376766816
  NPD (past)

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881663102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9936 MAIN ST",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-591-4884",
            "fax_number": "703-591-6932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9936 MAIN ST",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-591-4884",
            "fax_number": "703-591-6932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX EYE ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANGUIKIAN",
        "authorized_official_first_name": "DERTAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-591-4884",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101024017",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101051247",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6343643",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fairfax Dental Center
• Fairfax Dental Esthetics
• Fairfax Dental Partners, PC
• Fairfax Dentistry, PLLC
• Fairfax Endoscopy Center LLC
• Fairfax Eye Center, PC
• Fairfax Eye Docs, LLC
• Fairfax Family Life Behavioral Health, LLC
• Fairfax Family Practice Centers PC
• Fairfax Family Practice Centers, P.C

• Ophthalmology Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Ophthalmology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.