Individual
DR. ANTHONY BARDIA KOUCHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5701 COLUMBIA PIKE STE C1, FALLS CHURCH, VA 22041-2900
(703) 671-1400
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000564
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9236937
—
VA
Enumeration date
11/01/2006
Last updated
05/28/2020
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