NPIMap

Organization Active NPI

Gene Sweetnam, O.D., P.C.

  • Optometrist
  • Burke, VA
National Provider Identifier
1932281532
Registry record updated Nov 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618-000626 Issued in VA
Legal business name
GENE SWEETNAM, O.D., P.C.
Practice address
5204A Rolling Rd
Burke Professional Center
Burke, VA 22015-1605
Phone
(703) 425-2000
Fax
(703) 425-2003
NPI assigned
Oct 20, 2006
Last updated
Nov 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2007

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

Authorized official

Name
Dr. Gene Sweetnam, O.D.NPI 1972560241
Title
Owner
Phone
(703) 425-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618-000626 VA Primary

Addresses

Primary practice location

5204A Rolling Rd
Burke Professional Center
Burke, VA 22015-1605

Mailing address

5204A Rolling Rd
Burke Professional Center
Burke, VA 22015-1605
Phone (703) 425-2000

Other identifiers 1

IdentifierTypeStateIssuer
0618000626OtherVAVIRGINIA LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080821000141 DC Part B Supplier - Clinic/Group Practice 5698777985 Receives reassigned benefits from 3 practitioners
Practice locations: Burke, VA

National Provider Directory

National Provider Directory

Locations

5204 Rolling Rd
#A
Burke, VA 22015
Phone (703) 425-2000

5206 Rolling Rd
Ste A
Burke, VA 22015
Phone (703) 425-2000

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195776000000",
    "number": "1932281532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5204A ROLLING RD",
            "address_2": "BURKE PROFESSIONAL CENTER",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220151605",
            "telephone_number": "703-425-2000",
            "fax_number": "703-425-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5204A ROLLING RD",
            "address_2": "BURKE PROFESSIONAL CENTER",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220151605",
            "telephone_number": "703-425-2000",
            "fax_number": "703-425-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENE SWEETNAM, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-11-23",
        "status": "A",
        "authorized_official_last_name": "SWEETNAM",
        "authorized_official_first_name": "GENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-425-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618-000626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA LICENSE NUMBER",
            "identifier": "0618000626",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; 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.