Organization
PEYAM MOJALLAL OD AND ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PEYAM MOJALLAL OD (OWNER PRESIDENT)
(703) 723-3433
Entity
Organization
Contact information
Practice address
20600 GORDON PARK SQ, SUITE 150, ASHBURN, VA 20147-3145
(703) 723-7117
Mailing address
PO BOX 641, ASHBURN, VA 20146-0641
(703) 723-7117
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001051
VA
Other
Enumeration date
02/13/2007
Last updated
10/29/2007
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