Provider Demographics
NPI:1285288506
Name:DZUGUIA, FABRICE DJOKO (OD)
Entity type:Individual
Prefix:DR
First Name:FABRICE
Middle Name:DJOKO
Last Name:DZUGUIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:17301 VALLEY MALL RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6966
Practice Address - Country:US
Practice Address - Phone:301-582-1771
Practice Address - Fax:301-582-4681
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2073152W00000X
VA0618003046152W00000X
MDTA2685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA$$$$$$$$$Medicaid