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General NPI Number Information
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NPI Number | 1871734665
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Entity Type | Organization
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Legal Business Name | OPHTHALMOPATHY EYE CLINIC, LLC
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 2110 C GALLOWS RD SUITE # 2
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City | VIENNA
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State | VA
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Zip | 22182-3962
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Country | US
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Telephone | 703-918-0020
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Fax | 703-918-0026
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Provider Business Mailing Address
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Address Line | 2110 C GALLOWS RD SUITE # 2
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City | VIENNA
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State | VA
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Zip | 22182-3962
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Country | US
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Telephone | 703-918-0020
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Fax | 703-918-0026
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Authorized Official
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Title or Position | OWNER/ MEDICAL DIRECTOR
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Name | DR. ARMIN NAMAZIZADEH
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Credential | O.D.
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Telephone | 703-918-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0618001615
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License Number State | VA
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