Provider Demographics
NPI:1982265047
Name:GEBRAN, JASON (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:GEBRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 HIDDENITE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2419
Mailing Address - Country:US
Mailing Address - Phone:703-401-9971
Mailing Address - Fax:
Practice Address - Street 1:515 BROAD ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2734
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist