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Individual

MISS SHAYESTEH MARYAM IZADDOOST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
2480 LLEWELLYN AVE, FORT GEORGE G MEADE, MD 20755-7081
(301) 677-8950
Mailing address
2480 LLEWELLYN AVE, FORT GEORGE G MEADE, MD 20755-7081
(301) 677-8950

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618002983
VA
152W00000X
Optometrist
Primary
7031TG
TX
152W00000X
Optometrist
OPT002693
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7031TG
LICENSE (THERA GLAUC)
TX
Enumeration date
03/06/2007
Last updated
08/25/2022
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