Provider Demographics
NPI:1346961372
Name:AKHTAR, SHUAYB (OD)
Entity Type:Individual
Prefix:DR
First Name:SHUAYB
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MR
Other - First Name:SHOAIB
Other - Middle Name:
Other - Last Name:AKHTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-233-6780
Practice Address - Street 1:30 SHINING WILLOW WAY STE 30B
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4383
Practice Address - Country:US
Practice Address - Phone:240-523-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist