Basic Information
| Provider Information | |||||||||
| NPI: | 1558417709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOZOONI | ||||||||
| FirstName: | YASMINE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3728 WINDOM PL NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200162239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024391514 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1808 I ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200065416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023313931 | ||||||||
| FaxNumber: | 2023313932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2007 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618001067 | VA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OP1000061 | DC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.