Provider Demographics
NPI:1003822834
Name:DARVISH, SAADI MARCO (OD)
Entity Type:Individual
Prefix:DR
First Name:SAADI
Middle Name:MARCO
Last Name:DARVISH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 VILLAGE CREEK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4451
Mailing Address - Country:US
Mailing Address - Phone:972-931-1133
Mailing Address - Fax:972-931-5546
Practice Address - Street 1:1208 VILLAGE CREEK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4451
Practice Address - Country:US
Practice Address - Phone:972-931-1133
Practice Address - Fax:972-931-5546
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5064TG152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
FLTPOP45152W00000X
MDTA1207152W00000X
PAOEG003773152W00000X
WI21290-875152W00000X
VA0618002214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80582QOtherBLUE CROSS BLUE SHIELD ID
TXU83363Medicare UPIN
TX80582QOtherBLUE CROSS BLUE SHIELD ID