Provider Demographics
NPI:1306361282
Name:EMAMI, SAHAR MOGHADAM (OD)
Entity Type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:MOGHADAM
Last Name:EMAMI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:401 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4222
Practice Address - Country:US
Practice Address - Phone:703-938-5544
Practice Address - Fax:571-367-7620
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618002611OtherVIRGINIA LICENSE OF OPTOMETRY