Healthcare Provider Details

I. General information

NPI: 1245177989
Provider Name (Legal Business Name): MICHEAL RAMBOULI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 W CARY ST
RICHMOND VA
23221-2729
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 804-750-7113
  • Fax:
Mailing address:
  • Phone: 703-847-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003638
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: