Provider Demographics
NPI:1285015784
Name:NAVID REZA KHOSHOOEE OD LLC
Entity Type:Organization
Organization Name:NAVID REZA KHOSHOOEE OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:KHOSHOOEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-749-8670
Mailing Address - Street 1:1112 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1816
Mailing Address - Country:US
Mailing Address - Phone:407-749-8670
Mailing Address - Fax:
Practice Address - Street 1:1112 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-1816
Practice Address - Country:US
Practice Address - Phone:407-749-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty