Provider Demographics
NPI:1366691826
Name:MOSHTAGHFARD, ROSHANAK (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:MOSHTAGHFARD
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 1:3710 RAWLINS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:214-953-3937
Mailing Address - Fax:214-953-1892
Practice Address - Street 1:3710 RAWLINS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:214-953-3937
Practice Address - Fax:214-953-1892
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7319T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21909Medicare PIN