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General NPI Number Information
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NPI Number | 1124640289
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Entity Type | Organization
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Legal Business Name | DULLES FAMILY EYECARE LLC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 24635 DULLES LANDING DR
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City | DULLES
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State | VA
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Zip | 20166-2614
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Country | US
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Telephone | 703-270-1190
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Fax | 703-270-1190
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Provider Business Mailing Address
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Address Line | 6603 HARNESS HILL CT
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City | CENTREVILLE
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State | VA
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Zip | 20121-3817
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Country | US
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Telephone | 703-969-8748
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Fax | 703-270-1191
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MOJGAN HAGHSHENAS
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Credential | OD
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Telephone | 703-270-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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