Provider Demographics
NPI:1124243860
Name:AZIMI GREEN, MEHRNAZ DEHGHAN (OD)
Entity type:Individual
Prefix:DR
First Name:MEHRNAZ
Middle Name:DEHGHAN
Last Name:AZIMI GREEN
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 1:6900 WISCONSIN AVE
Mailing Address - Street 2:STE. 600
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6114
Mailing Address - Country:US
Mailing Address - Phone:301-951-0320
Mailing Address - Fax:301-951-0370
Practice Address - Street 1:6900 WISCONSIN AVE
Practice Address - Street 2:STE. 600
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6114
Practice Address - Country:US
Practice Address - Phone:301-951-0320
Practice Address - Fax:301-951-0370
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1869152W00000X, 152WP0200X, 152WV0400X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision