Healthcare Provider Details

I. General information

NPI: 1275695637
Provider Name (Legal Business Name): OSMAN Y. SHEIKH LICENSED OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6399 LITTLE RIVER TPKE STE 203
ALEXANDRIA VA
22312-5093
US

IV. Provider business mailing address

6399 LITTLE RIVER TPKE STE 203
ALEXANDRIA VA
22312-5093
US

V. Phone/Fax

Practice location:
  • Phone: 703-354-4455
  • Fax: 703-354-4455
Mailing address:
  • Phone: 703-354-4455
  • Fax: 703-354-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1101003163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: