Provider Demographics
NPI:1063773471
Name:RAMEDANI, ASAB
Entity type:Individual
Prefix:MR
First Name:ASAB
Middle Name:
Last Name:RAMEDANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 WISCONSIN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3310
Mailing Address - Country:US
Mailing Address - Phone:202-337-8969
Mailing Address - Fax:
Practice Address - Street 1:1330 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3310
Practice Address - Country:US
Practice Address - Phone:202-337-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPENDINGMedicaid