Healthcare Provider Details

I. General information

NPI: 1477048452
Provider Name (Legal Business Name): ANAHITA ABAZARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 WOODMONT AVE
BETHESDA MD
20814-2743
US

IV. Provider business mailing address

3318 JONES BRIDGE CT
CHEVY CHASE MD
20815-5737
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-2027
  • Fax:
Mailing address:
  • Phone: 301-919-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003405
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002789
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10384T
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2674
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: