Active NPI
Tewodros Gedamu, O.D. & Associates, LLC
- Optometrist
- Fairfax, VA
National Provider Identifier
1114101425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 06180001068
- Legal business name
- TEWODROS GEDAMU, O.D. & ASSOCIATES, LLC
- Practice address
- 11784 Lee Jackson Memorial Highway
Fairoaks Mall Lower Level
Fairfax, VA 22033 - Phone
- (703) 591-9377
- Fax
- (703) 591-9377
- NPI assigned
- Dec 21, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tewodros Gedamu, O.D.
- Title
- Member
- Phone
- (703) 591-9377
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 06180001068 | VA | Primary |
Addresses
Primary practice location
11784 Lee Jackson Memorial Highway
Fairoaks Mall Lower Level
Fairfax, VA 22033
Mailing address
11654 Plaza America Dr Ste 194
Reston, VA 20190-4700
Phone (703) 591-9377
Other names 1
- Dr. Tewodros Gedamu & Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
11784L Fair Oaks Mall
Fairfax, VA 22033
Phone (703) 591-9377
11654 Plaza America Dr
Reston, VA 20190
Phone (703) 437-1160
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Low Vision Rehabilitation Optometrist
- Ashburn, VA
- NPI 1154378511
-
- Optometrist
- Fairfax, VA
- NPI 1982744124
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198195200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1772668800000",
"number": "1114101425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11654 PLAZA AMERICA DR STE 194",
"city": "RESTON",
"state": "VA",
"postal_code": "201904700",
"telephone_number": "703-591-9377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11784 LEE JACKSON MEMORIAL HIGHWAY",
"address_2": "FAIROAKS MALL LOWER LEVEL",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "22033",
"telephone_number": "703-591-9377",
"fax_number": "703-591-9377"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TEWODROS GEDAMU, O.D. & ASSOCIATES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-12-21",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A",
"authorized_official_last_name": "GEDAMU",
"authorized_official_first_name": "TEWODROS",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "703-591-9377",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Optometrist",
"state": "VA",
"license": "06180001068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Dr. Tewodros Gedamu & Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.