Provider Demographics
NPI:1427062280
Name:FAROUQ, ANNA H (OD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:H
Last Name:FAROUQ
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 1:15243 FOREST RD
Mailing Address - Street 2:STE E
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4974
Mailing Address - Country:US
Mailing Address - Phone:434-525-2830
Mailing Address - Fax:
Practice Address - Street 1:15243 FOREST RD
Practice Address - Street 2:STE E
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4974
Practice Address - Country:US
Practice Address - Phone:434-525-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3946873OtherMEDICARE ID
VA0618001805OtherSTATE LICENSE
VA0618001805OtherSTATE LICENSE
VA0618001805OtherSTATE LICENSE