MEDICARE: KAJAL DHEBARIA O.D.

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
1	152W00000X	Optometrist	2272	NC
2	152WP0200X	Pediatric Optometrist	2272	NC
3	152WC0802X	Corneal and Contact Management Optometrist	2272	NC
4	152WX0102X	Occupational Vision Optometrist	2272	NC

General Provider Information

NPI Number	:	1609126341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAJAL DHEBARIA O.D.

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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8511 COLONNADE CENTER DR STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-5846
Country	:	US
Telephone Number	:	919-977-0303
Fax Number	:	919-977-0410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	12/15/2025

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