Provider Demographics
NPI:1912768284
Name:VARELA ROSA, VIVIANA (OD)
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:VARELA ROSA
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 1:1809 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3247
Mailing Address - Country:US
Mailing Address - Phone:703-273-6323
Mailing Address - Fax:
Practice Address - Street 1:10690 FAIRFAX BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4321
Practice Address - Country:US
Practice Address - Phone:703-273-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003354152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist