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NPI Code Detail

MEDICARE: GABRIELLE LASHELL GAFFORD OD

MEDICARE: GABRIELLE LASHELL GAFFORD OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist27OA00713600NJ
2152W00000XOptometristTA3012MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1136295489OTHERTNDRIVERS LICENSE

General Provider Information

NPI Number : 1588396386
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE LASHELL GAFFORD OD
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 3309 FORESTVILLE PL
Second Line :
City : FORESTVILLE
State : MD
Zip : 20747-4409
Country : US
Telephone Number : 301-420-6610
Fax Number : 301-735-0294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2022
Last Update Date : 08/01/2024

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