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General NPI Number Information
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NPI Number | 1477984821
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Entity Type | Organization
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Legal Business Name | OPTICAL ILLUSIONS INC.
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 8990 FERN PARK DRIVE SUITE A
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City | BURKE
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State | VA
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Zip | 22015-2201
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Country | US
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Telephone | 34-250-6007
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Fax | 703-425-3982
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Provider Business Mailing Address
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Address Line | 8990 FERN PK DR, SUITE A
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City | BURKE
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State | VA
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Zip | 22015-2539
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Country | US
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Telephone | 703-425-0600
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Fax | 703-425-3982
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. RANA IMAN
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Credential | O.D.
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Telephone | 703-425-0600
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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 | 0618001010
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License Number State | VA
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