Provider Demographics
NPI:1124640289
Name:DULLES FAMILY EYECARE LLC
Entity type:Organization
Organization Name:DULLES FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHSHENAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-270-1190
Mailing Address - Street 1:6603 HARNESS HILL CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3817
Mailing Address - Country:US
Mailing Address - Phone:703-969-8748
Mailing Address - Fax:703-270-1191
Practice Address - Street 1:24635 DULLES LANDING DR
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2614
Practice Address - Country:US
Practice Address - Phone:703-270-1190
Practice Address - Fax:703-270-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty