Provider Demographics
NPI:1073763371
Name:PAKZAD, MINA (OD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:PAKZAD
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 1:2501 W MEMORIAL RD
Mailing Address - Street 2:SUITE 259A
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-749-0220
Mailing Address - Fax:
Practice Address - Street 1:2501 W MEMORIAL RD
Practice Address - Street 2:SUITE 259A
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-749-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist