Provider Demographics
NPI:1063424406
Name:IMAN, RANA (OD)
Entity type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:IMAN
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 1:8990 FERN PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2539
Mailing Address - Country:US
Mailing Address - Phone:703-425-0600
Mailing Address - Fax:703-425-3982
Practice Address - Street 1:8990 FERN PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2539
Practice Address - Country:US
Practice Address - Phone:703-425-0600
Practice Address - Fax:703-425-3982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U35065Medicare UPIN