Provider Demographics
NPI:1538544457
Name:ABEBE, MEKLIT M (OD)
Entity type:Individual
Prefix:
First Name:MEKLIT
Middle Name:M
Last Name:ABEBE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEKLIT
Other - Middle Name:MILLION
Other - Last Name:ABEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:22000 DULLES RETAIL PLZ STE 168
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-2517
Practice Address - Country:US
Practice Address - Phone:703-421-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2474152W00000X
VA0618002471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist