Provider Demographics
NPI:1053419895
Name:LOBAUGH, ELIZABETH ANN (OD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:LOBAUGH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:MCHUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3800 NORTH FAIRFAX DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-522-3454
Mailing Address - Fax:703-522-9636
Practice Address - Street 1:3800 N FAIRFAX DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-522-3454
Practice Address - Fax:703-522-9636
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U76827Medicare UPIN
004044L49Medicare ID - Type Unspecified