Provider Demographics
NPI:1104013200
Name:FARAJNIA, SOLMAZ (OD)
Entity Type:Individual
Prefix:
First Name:SOLMAZ
Middle Name:
Last Name:FARAJNIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6509
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:2700 POTOMAC MILLS CIR
Practice Address - Street 2:105
Practice Address - City:PRINCE WILLIAM
Practice Address - State:VA
Practice Address - Zip Code:22192-4625
Practice Address - Country:US
Practice Address - Phone:703-494-0660
Practice Address - Fax:703-497-4605
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist