Provider Demographics
NPI:1194382861
Name:PAKZAD, TANYA (OD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
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 1:2000 SALZEDO ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4345
Mailing Address - Country:US
Mailing Address - Phone:240-888-8032
Mailing Address - Fax:
Practice Address - Street 1:8430 MILLS DR
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:FL
Practice Address - Zip Code:33183-4807
Practice Address - Country:US
Practice Address - Phone:305-279-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty