Individual
DEENA TAILOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
21475 RIDGETOP CIR STE 300, STERLING, VA 20166-8580
(703) 430-4400
Mailing address
7310 17TH AVE, HYATTSVILLE, MD 20783-4327
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002579
VA
152WC0802X
Corneal and Contact Management Optometrist
0618002579
VA
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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