Provider Demographics
NPI:1538410295
Name:ABBASI-COOPER, FATEMEH (OD)
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:ABBASI-COOPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:FATEMEH
Other - Middle Name:
Other - Last Name:ABBASI MARDKHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8604 BUCKHANNON DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3505
Mailing Address - Country:US
Mailing Address - Phone:571-218-9697
Mailing Address - Fax:
Practice Address - Street 1:2101 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4908
Practice Address - Country:US
Practice Address - Phone:301-810-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist