Individual
MARTIN A SHAHMIRZADI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1934 OLD GALLOWS RD STE 350B, VIENNA, VA 22182-4042
(703) 568-5076
Mailing address
1934 OLD GALLOWS RD STE 350B, VIENNA, VA 22182-4042
(703) 568-5076
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1101003537
VA
Other
Enumeration date
09/02/2020
Last updated
09/02/2020
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