Provider Demographics
NPI:1558417709
Name:FOZOONI, YASMINE (OD)
Entity Type:Individual
Prefix:
First Name:YASMINE
Middle Name:
Last Name:FOZOONI
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 1:3728 WINDOM PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2239
Mailing Address - Country:US
Mailing Address - Phone:202-439-1514
Mailing Address - Fax:
Practice Address - Street 1:1808 I ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-5416
Practice Address - Country:US
Practice Address - Phone:202-331-3931
Practice Address - Fax:202-331-3932
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001067152W00000X
DCOP1000061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist