Provider Demographics
NPI:1093970063
Name:MOTEDAEINY, AFROUZ (OD)
Entity Type:Individual
Prefix:
First Name:AFROUZ
Middle Name:
Last Name:MOTEDAEINY
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 1:800 DOUGLAS ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2087
Mailing Address - Country:US
Mailing Address - Phone:305-461-0212
Mailing Address - Fax:305-461-0208
Practice Address - Street 1:800 DOUGLAS ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2087
Practice Address - Country:US
Practice Address - Phone:305-461-0212
Practice Address - Fax:305-461-0208
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAN376ZMedicare PIN