Provider Demographics
NPI:1659372993
Name:RAHMAN, AYESHA MECCI (OD)
Entity Type:Individual
Prefix:
First Name:AYESHA
Middle Name:MECCI
Last Name:RAHMAN
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 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-461-1444
Mailing Address - Fax:757-461-8238
Practice Address - Street 1:885 KEMPSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-461-1444
Practice Address - Fax:757-461-8238
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601009768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA600214864OtherCIGNA PROV #
VA2200149OtherUNTIED HEALTH PROV #
VA215754OtherANTHEM PROV #
VA215754OtherHEALTHKEEPERS PROV #
VA480028785OtherRAILROAD MEDICARE PROV #
VA541299712OtherSUPERIOR VISION PROV #
VA22440OtherOPTIMA PROV #
VA11529OtherCOORDINATED VISION PROV #
VA27334OtherMD IPA PROV #
VA7556210OtherAETNA PROV #
VA9235779Medicaid
VA541299712OtherVA HEALTH NETWORK PROV #
VAU79144Medicare UPIN
VA11529OtherCOORDINATED VISION PROV #