MEDICARE: REMA IDRISS 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
1	152W00000X	Optometrist	1601	NE
2	152W00000X	Optometrist	0618003319	VA

General Provider Information

NPI Number	:	1932772944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REMA IDRISS OD

Provider Business Mailing Address
First Line	:	2005 S FINLEY RD UNIT 504
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6490
Country	:	US
Telephone Number	:	402-301-0726
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 TRAFORD LN
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1664
Country	:	US
Telephone Number	:	703-569-6363
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	08/05/2025

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Directions to “ REMA IDRISS OD” Practice Location

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