Provider Demographics
NPI:1144386608
Name:SHARMA, TANYA (OD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11784-L LEE JACKSON MEM. HWY.
Mailing Address - Street 2:FAIR OAKS MALL
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-591-9377
Mailing Address - Fax:
Practice Address - Street 1:11784-L LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:FAIR OAKS MALL
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-591-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist