Provider Demographics
NPI:1073948311
Name:ANWARI, ORBAL MARIAM
Entity Type:Individual
Prefix:
First Name:ORBAL
Middle Name:MARIAM
Last Name:ANWARI
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 1:9405 LIBERIA AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-1718
Mailing Address - Country:US
Mailing Address - Phone:703-722-4915
Mailing Address - Fax:
Practice Address - Street 1:9405 LIBERIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1718
Practice Address - Country:US
Practice Address - Phone:703-722-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3511AT152W00000X
VA0618003113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist