Provider Demographics
NPI:1780097212
Name:FEREYDOUNI, ROSHANAK (OD)
Entity type:Individual
Prefix:
First Name:ROSHANAK
Middle Name:
Last Name:FEREYDOUNI
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 1:8614 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 1:635 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4303
Practice Address - Country:US
Practice Address - Phone:202-546-2838
Practice Address - Fax:202-543-3033
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002538152W00000X
PAOEG002905152W00000X
MDTA2566152W00000X
DCOP1000360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist