Basic Information
| Provider Information | |||||||||
| NPI: | 1386678324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGHSHENAS | ||||||||
| FirstName: | MOJGAN | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 7038475177 | ||||||||
| Practice Location | |||||||||
| Address1: | 14245E CENTREVILLE SQ | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201212368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038302010 | ||||||||
| FaxNumber: | 7038187014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA1688 | MD | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618001066 | VA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.