Moa Mid-Atlantic LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MOA MID-ATLANTIC LLC

Practice address

3910 Centreville Rd Ste 102
Chantilly, VA 20151-3280

Phone

(703) 719-8811

Fax

(703) 263-2441

NPI assigned

Nov 10, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert M Allen, OD

Title

Ceo / Doctor

Phone

(703) 719-8811

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1073279378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 CENTREVILLE RD STE 102",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201513280",
            "telephone_number": "703-719-8811",
            "fax_number": "703-263-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 CENTREVILLE RD STE 102",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201513280",
            "telephone_number": "703-719-8811",
            "fax_number": "703-263-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOA MID-ATLANTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-10",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO / DOCTOR",
        "authorized_official_telephone_number": "703-719-8811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahnoor Mirza
• Kiana Kyle D. Misterio, OTR/L
• Erin Mitchell, NP
• Mercy Mkorombindo, FNP
• Moa Mid-Atlantic Chantilly PC
• Daren Moat, PT
• Modaresi & Avin DDS PLLC
• Modi & Associates P.C.
• Orli Elizabeth Modi-Skeath, DPT
• Mahdi Mojarrad, DMD

• Optometrist in Chantilly, VA
• Providers in Chantilly, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.