Provider Demographics
NPI:1629098439
Name:FARAHMAND, NEDA (OD)
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:FARAHMAND
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
Mailing Address - Street 2:STE. 100
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-847-5177
Practice Address - Street 1:7367 ATLAS WALK WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2992
Practice Address - Country:US
Practice Address - Phone:703-753-7200
Practice Address - Fax:703-753-7661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10313295Medicaid
11609701OtherCAQH NUMBER
C10284Medicare PIN