Healthcare Provider Details

I. General information

NPI: 1790614584
Provider Name (Legal Business Name): DC EYE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8381 OLD COURTHOUSE RD STE 345
VIENNA VA
22182-4103
US

IV. Provider business mailing address

13120 MADONNA LN
FAIRFAX VA
22033-3707
US

V. Phone/Fax

Practice location:
  • Phone: 703-856-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AAZIM AHMED SIDDIQUI
Title or Position: OWNER
Credential: MD
Phone: 703-856-0801