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General NPI Number Information
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NPI Number | 1073403440
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Entity Type | Individual
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Provider Name | NEGIN AZHANDEH O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 25055 RIDING PLZ STE 100
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City | CHANTILLY
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State | VA
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Zip | 20152-5918
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Country | US
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Telephone | 703-957-3384
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Fax | 703-957-3387
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Provider Business Mailing Address
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Address Line | 25055 RIDING PLZ STE 100
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City | CHANTILLY
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State | VA
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Zip | 20152-5918
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Country | US
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Telephone | 703-957-3384
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Fax | 703-957-3387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 0618003541
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618003541
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License Number State | VA
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