Provider Demographics
NPI:1235621574
Name:QURAISHI, ELHAM (OD)
Entity Type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:QURAISHI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4604
Mailing Address - Country:US
Mailing Address - Phone:703-471-7810
Mailing Address - Fax:
Practice Address - Street 1:709 PINE ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4604
Practice Address - Country:US
Practice Address - Phone:703-471-7810
Practice Address - Fax:703-471-6549
Is Sole Proprietor?:No
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist