Provider Demographics
NPI:1225390446
Name:HOSSEINI, BABAK (OD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11739 DEVILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3405
Mailing Address - Country:US
Mailing Address - Phone:240-281-3145
Mailing Address - Fax:
Practice Address - Street 1:7101 DEMOCRACY BLVD
Practice Address - Street 2:SUITE 1800
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1018
Practice Address - Country:US
Practice Address - Phone:301-365-3670
Practice Address - Fax:301-365-4583
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist