Provider Demographics
NPI:1326933458
Name:MOAPICHAI, CHANTANA MELANIE (OD)
Entity type:Individual
Prefix:DR
First Name:CHANTANA
Middle Name:MELANIE
Last Name:MOAPICHAI
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 1:9600 MAIN ST STE H
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3798
Mailing Address - Country:US
Mailing Address - Phone:703-764-3937
Mailing Address - Fax:
Practice Address - Street 1:9600 MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3798
Practice Address - Country:US
Practice Address - Phone:703-764-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003505152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation