Provider Demographics
NPI:1659490142
Name:SLAVIN, DIANA J (OD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:J
Last Name:SLAVIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:3910 CENTREVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3280
Practice Address - Country:US
Practice Address - Phone:703-830-6380
Practice Address - Fax:703-263-2441
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001098152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics