Healthcare Provider Details

I. General information

NPI: 1104013200
Provider Name (Legal Business Name): SOLMAZ FARAJNIA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 GORDON PARK SQ STE 150
ASHBURN VA
20147-3145
US

IV. Provider business mailing address

20600 GORDON PARK SQ STE 150
ASHBURN VA
20147-3145
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-3433
  • Fax: 703-723-1920
Mailing address:
  • Phone: 703-723-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP1000177
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618001685
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001685
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: