Provider Demographics
NPI:1083685234
Name:VAZIRI, BOYD (MD)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:
Last Name:VAZIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9617 GULF RESEARCH LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4555
Mailing Address - Country:US
Mailing Address - Phone:239-418-0999
Mailing Address - Fax:
Practice Address - Street 1:9617 GULF RESEARCH LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4555
Practice Address - Country:US
Practice Address - Phone:239-418-0999
Practice Address - Fax:239-274-0773
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902683Medicaid
NC5902683Medicaid
NCI34699Medicare UPIN