Mohammad Ashfaq, OD
Individual provider Active NPI Optometrist · Woodbridge, VA
NPI 1396992145 · NPPES record last updated Oct 16, 2013
Key facts
- NPI
- 1396992145
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 0618001741 (VA)
- Practice address
- 14130 Noblewood PLZ
Unit 105
Woodbridge, VA 22193-1464 - Phone
- (703) 878-2020
- Fax
- (703) 878-2020
- NPI assigned
- Aug 23, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111205000810 | VA | Practitioner - Optometry | 5193881381 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA2098 | MD | MD | Optometrist |
| 0618001741 | VA | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA2098 | MD | |
| Optometrist | 152W00000X | 0618001741 | VA | Yes |
Addresses
Primary practice location
14130 Noblewood PLZ
Unit 105
Woodbridge, VA 22193-1464
Mailing address
14599 Charity CT
Woodbridge, VA 22193-1200
Phone (703) 878-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 363066 | Other | VA | ANTHEM BCBS |
| 1396992145 | Medicaid | VA |
Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.