MEDICARE: AFSOON KHOSHNEVIS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		VA

General Provider Information

NPI Number	:	1710099056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFSOON KHOSHNEVIS O.D.

Provider Business Mailing Address
First Line	:	8370 GREENSBORO DR APT 621
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22102-3517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6050 GORGAS RD
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-6206
Country	:	US
Telephone Number	:	703-781-3695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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