Provider Demographics
NPI:1023430477
Name:MOINIFAR, MICHELLE (OD)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:MOINIFAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:24570 DULLES LANDING DR UNIT 170
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-2623
Practice Address - Country:US
Practice Address - Phone:571-367-7610
Practice Address - Fax:571-367-7620
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14818152W00000X
DCOP1000274152W00000X
VA0618003351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist