Provider Demographics
NPI:1710401195
Name:AL-GHANDOUR, NADEEN (OD)
Entity Type:Individual
Prefix:
First Name:NADEEN
Middle Name:
Last Name:AL-GHANDOUR
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:
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:866-795-4020
Practice Address - Street 1:5426 JEFFERSON DAVIS HWY STE 104
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2616
Practice Address - Country:US
Practice Address - Phone:540-891-2020
Practice Address - Fax:540-898-5005
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist