Provider Demographics
NPI:1164837258
Name:FALLAHZADEH, MORVARID (OD)
Entity Type:Individual
Prefix:
First Name:MORVARID
Middle Name:
Last Name:FALLAHZADEH
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 1:13950 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3001
Mailing Address - Country:US
Mailing Address - Phone:954-817-9646
Mailing Address - Fax:
Practice Address - Street 1:1673 MARKET ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3663
Practice Address - Country:US
Practice Address - Phone:954-384-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist