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General NPI Number Information
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NPI Number | 1831504976
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Entity Type | Individual
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Provider Name | ANSU MARIAM NATHAN O.D
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Gender | Female
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 8369 LEESBURG PIKE STE A
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City | VIENNA
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State | VA
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Zip | 22182-2421
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Country | US
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Telephone | 703-506-0000
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Fax | 703-506-0705
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Provider Business Mailing Address
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Address Line | 1950 OLD GALLOWS RD STE 520
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City | VIENNA
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State | VA
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Zip | 22182-3970
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Country | US
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Telephone | 703-847-8899
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Fax | 866-795-4020
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5321
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License Number State | FL
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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 | 0618002626
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.010812
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA2621
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License Number State | MD
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