Healthcare Provider Details

I. General information

NPI: 1932772944
Provider Name (Legal Business Name): REMA IDRISS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/05/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 TRAFORD LN
SPRINGFIELD VA
22152-1664
US

IV. Provider business mailing address

2005 S FINLEY RD UNIT 504
LOMBARD IL
60148-6490
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-6363
  • Fax:
Mailing address:
  • Phone: 402-301-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1601
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: