Individual provider Active NPI

Sahar Moghadam Emami, OD

  • Optometrist
  • Vienna, VA
National Provider Identifier
1306361282
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618002611 Issued in VA
Practice address
401 Maple Ave W
Vienna, VA 22180-4222
Phone
(703) 938-5544
Fax
(571) 367-7620
NPI assigned
Aug 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618002611 VA Primary

Addresses

Primary practice location

401 Maple Ave W
Vienna, VA 22180-4222

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other identifiers 1

IdentifierTypeStateIssuer
0618002611OtherVAVIRGINIA LICENSE OF OPTOMETRY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20241028001469 NJ Practitioner - Optometry 8123381894 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
International American University at Puerto Rico - School of Optometry, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pink Vision Associates LLCGroup PAC ID 6002087343, 4 clinicians

Practice addresses (Care Compare)

685 Kearny Ave
Kearny, NJ 07032-3009
Phone (201) 461-0020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0618002611VAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pink Vision Associates LLC Optometrist CurrentSince Sep 1, 2024 Accepting new patients

Locations

1068 Clinton Ave
Irvington, NJ 07111
Phone (973) 399-0909

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": "1502409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1306361282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "866-795-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MAPLE AVE W",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804222",
            "telephone_number": "703-938-5544",
            "fax_number": "571-367-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMAMI",
        "first_name": "SAHAR",
        "middle_name": "MOGHADAM",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-11",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA LICENSE OF OPTOMETRY",
            "identifier": "0618002611",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vienna, VA

Sources for this page

Verify at the official NPI Registry.