Individual provider Active NPI

Tanya Sharma, OD

  • Optometrist
  • Fairfax, VA
National Provider Identifier
1144386608
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618001517 Issued in VA
Practice address
11784-L Lee Jackson Memorial Hwy
Fair Oaks Mall
Fairfax, VA 22033
Phone
(703) 591-9377
NPI assigned
Dec 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618001517 VA Primary

Addresses

Primary practice location

11784-L Lee Jackson Memorial Hwy
Fair Oaks Mall
Fairfax, VA 22033

Mailing address

11784-L Lee Jackson Mem. Hwy.
Fair Oaks Mall
Fairfax, VA 22033
Phone (703) 591-9377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070306000279 DC Practitioner - Optometry 8426151895 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tewodros Gedamu, O.D. & Associates, LLC Optometrist CurrentSince May 4, 2016 Accepting new patients

Locations

3070 Bristol Pike
Ste 2-220
Bensalem, PA 19020
Phone 2144971001108

11784L Fair Oaks Mall
Fairfax, VA 22033
Phone (703) 591-9377

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1144386608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11784-L LEE JACKSON MEM. HWY.",
            "address_2": "FAIR OAKS MALL",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22033",
            "telephone_number": "703-591-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11784-L LEE JACKSON MEMORIAL HWY",
            "address_2": "FAIR OAKS MALL",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22033",
            "telephone_number": "703-591-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARMA",
        "first_name": "TANYA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-29",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.