Provider Demographics
NPI:1477984821
Name:OPTICAL ILLUSIONS INC.
Entity Type:Organization
Organization Name:OPTICAL ILLUSIONS INC.
Other - Org Name:RANA IMAN, OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-425-0600
Mailing Address - Street 1:8990 FERN PK DR, SUITE A
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2539
Mailing Address - Country:US
Mailing Address - Phone:703-425-0600
Mailing Address - Fax:703-425-3982
Practice Address - Street 1:8990 FERN PARK DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2201
Practice Address - Country:US
Practice Address - Phone:034-250-6007
Practice Address - Fax:703-425-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063424406OtherTYPE 1 NPI
VAU35065Medicare UPIN