Provider Demographics
NPI:1043508161
Name:LATIFI, NAZANIN
Entity Type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:LATIFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SENECA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-1365
Mailing Address - Country:US
Mailing Address - Phone:703-774-6380
Mailing Address - Fax:
Practice Address - Street 1:165 SENECA RIDGE DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-1365
Practice Address - Country:US
Practice Address - Phone:703-774-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist