Provider Demographics
NPI:1417124678
Name:VAGHEDI, NIMA
Entity Type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:VAGHEDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S MONACO PKWY
Mailing Address - Street 2:#2B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 S MONACO PKWY
Practice Address - Street 2:#2B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3703
Practice Address - Country:US
Practice Address - Phone:303-377-0752
Practice Address - Fax:303-321-4113
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician