Provider Demographics
NPI:1437397171
Name:HOSSINI, PAYMON (OD)
Entity Type:Individual
Prefix:DR
First Name:PAYMON
Middle Name:
Last Name:HOSSINI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2707
Mailing Address - Country:US
Mailing Address - Phone:541-543-5578
Mailing Address - Fax:619-476-1250
Practice Address - Street 1:1150 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2707
Practice Address - Country:US
Practice Address - Phone:541-543-5578
Practice Address - Fax:619-476-1250
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33374TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist