Provider Demographics
NPI:1386678324
Name:HAGHSHENAS, MOJGAN (OD)
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:
Last Name:HAGHSHENAS
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 1:1950 OLD GALLOWS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3933
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-847-5177
Practice Address - Street 1:14245E CENTREVILLE SQ
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2368
Practice Address - Country:US
Practice Address - Phone:703-830-2010
Practice Address - Fax:703-818-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1688152W00000X
VA0618001066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA84133Medicare UPIN