Healthcare Provider Details

I. General information

NPI: 1053354399
Provider Name (Legal Business Name): SARA LEE AGGARWAL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 K ST NW 64
WASHINGTON DC
20001-8000
US

IV. Provider business mailing address

2101 E JEFFERSON ST STE 6 W - PPQA KAISER PERM
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 202-898-1060
  • Fax: 202-898-0472
Mailing address:
  • Phone: 301-816-5853
  • Fax: 301-816-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002022
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP1000225
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: