Provider Demographics
NPI:1629021449
Name:UNWALLA, DARAIUS ADI (OD)
Entity Type:Individual
Prefix:DR
First Name:DARAIUS
Middle Name:ADI
Last Name:UNWALLA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21100 DULLES TOWN CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2438
Mailing Address - Country:US
Mailing Address - Phone:703-421-9020
Mailing Address - Fax:703-421-7426
Practice Address - Street 1:21100 DULLES TOWN CIR STE 103
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2438
Practice Address - Country:US
Practice Address - Phone:703-421-9020
Practice Address - Fax:703-421-7426
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U34766Medicare UPIN
VAUN87046Medicare PIN