Provider Demographics
NPI:1376151043
Name:MOHEBBI HESARI, SHAGHAYEGH (OD)
Entity Type:Individual
Prefix:
First Name:SHAGHAYEGH
Middle Name:
Last Name:MOHEBBI HESARI
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 1:8416 E SHEA BLVD STE C-101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6666
Mailing Address - Country:US
Mailing Address - Phone:480-483-3937
Mailing Address - Fax:480-483-8813
Practice Address - Street 1:8416 E SHEA BLVD STE C-101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6666
Practice Address - Country:US
Practice Address - Phone:480-483-3937
Practice Address - Fax:480-483-8813
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT002536152W00000X
PAOEG003679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist