1659372993 NPI number — AYESHA MECCI RAHMAN O.D.

Table of content: AYESHA MECCI RAHMAN O.D. (NPI 1659372993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659372993 NPI number — AYESHA MECCI RAHMAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHMAN
Provider First Name:
AYESHA
Provider Middle Name:
MECCI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659372993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
885 KEMPSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-461-1444
Provider Business Mailing Address Fax Number:
757-461-8238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 KEMPSVILLE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-461-1444
Provider Business Practice Location Address Fax Number:
757-461-8238
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0601009768 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 600214864 . This is a "CIGNA PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2200149 . This is a "UNTIED HEALTH PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 215754 . This is a "ANTHEM PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 215754 . This is a "HEALTHKEEPERS PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 480028785 . This is a "RAILROAD MEDICARE PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541299712 . This is a "SUPERIOR VISION PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 22440 . This is a "OPTIMA PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11529 . This is a "COORDINATED VISION PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 27334 . This is a "MD IPA PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7556210 . This is a "AETNA PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9235779 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541299712 . This is a "VA HEALTH NETWORK PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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