Individual
DR. PEYAM MOJALLAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
20600 GORDON PARK SQ, SUITE 150, ASHBURN, VA 20147-3145
(703) 723-3433
(703) 723-1920
Mailing address
20600 GORDON PARK SQ, SUITE 150, ASHBURN, VA 20147-3145
(703) 723-3433
(703) 723-1920
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001051
VA
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
0618001051
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9236805
—
VA
Enumeration date
05/30/2006
Last updated
12/06/2007
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