Mojallal, Peyam
Mojallal, Peyam is an individual health care provider with primary practice located at 20600 Gordon Park Sq Suite 150, Ashburn VA 20147-3145. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Low Vision Rehabilitation. Eye and Vision Services Providers / Low Vision Rehabilitation is his primary health care specialty. Mojallal, Peyam can be contacted via phone (703) 723-3433.Contact Information
Primary practice address
20600 Gordon Park Sq Suite 150
Ashburn VA 20147-3145
Phone: (703) 723-3433
Fax: (703) 723-1920
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 0618001051 | Virginia |
| Eye and Vision Services Providers / Low Vision Rehabilitation | 152WL0500X | 0618001051 | Virginia |
Profile Details
| NPI number | 1154378511 |
|---|---|
| LBN Legal business name | Mojallal, Peyam |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 30th, 2006 |
| Last updated | Dec 6th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154378511 | NPPES |
| Virginia | MEDICAID | 9236805 |
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