Provider Demographics
NPI:1902831134
Name:KAPOOR, DIMPLE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIMPLE
Middle Name:
Last Name:KAPOOR
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 1:25055 RIDING PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5918
Mailing Address - Country:US
Mailing Address - Phone:703-957-3384
Mailing Address - Fax:703-961-9230
Practice Address - Street 1:25055 RIDING PLZ STE 100
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5918
Practice Address - Country:US
Practice Address - Phone:703-961-9119
Practice Address - Fax:703-961-9230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001301152WV0400X, 152WX0102X, 152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA412132083OtherGREATWEST
VA173375OtherANTHEM
VA2131697OtherUNITED HEALTH CARE
VA412132083OtherNCAS
VA2286069OtherFIRST HEALTH
VA3790430OtherAETNA
VA9364952OtherGUARDIAN
VAJ701-0002OtherBCBS CAREFIRST
VA692491OtherNCPPO
VAJ701-0020OtherBCBS CAREFIRST
VA9364952OtherP.H.C.S
VAJ701-0002OtherBCBS CAREFIRST
VA9364952OtherP.H.C.S