Provider Demographics
NPI:1306467691
Name:HASHIMI, SELMA
Entity type:Individual
Prefix:
First Name:SELMA
Middle Name:
Last Name:HASHIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SELMA
Other - Middle Name:
Other - Last Name:DAUD
Other - Suffix:
Other - Last Name Type:Other Name
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 1:875 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8479
Practice Address - Country:US
Practice Address - Phone:770-963-0370
Practice Address - Fax:770-963-0370
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist