Jeetandra M. Athelli, O.D.
Individual provider Active NPI Optometrist · Chantilly, VA
NPI 1902808181 · NPPES record last updated Jul 8, 2015
Key facts
- NPI
- 1902808181
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 0618000308 (VA)
- Practice address
- 14161A Robert Paris CT
Chantilly, VA 20151-4204 - Phone
- (703) 631-0014
- Fax
- (703) 449-8770
- NPI assigned
- Jun 1, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- State University of New York - State College Optometry, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
14161 A Robert Paris CT
A
Chantilly, VA 20151-4204
14161 A Robert Paris CT a
Chantilly, VA 20151-4204
Phone (703) 631-0014
14161 Robert Paris CT
Suite a
Chantilly, VA 20151-4238
400 Holiday CT
Warrenton, VA 20186-4349
Phone (540) 347-2217
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 20 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in DC, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080529000912 | DC | Practitioner - Optometry | 8426128695 | Practice locations: Chantilly, VA |
| I20111005000716 | VA | Practitioner - Optometry | 8426128695 | Practice locations: Warrenton, VA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618000308 | VA | Yes |
Addresses
Primary practice location
14161A Robert Paris CT
Chantilly, VA 20151-4204
Mailing address
400 Holiday CT 207
Warrenton, VA 20186-4349
Phone (540) 347-2217
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 437150 | Other | VA | ANTHEMBLUECROSSBLUESHIELD |
Other providers in Chantilly, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.