Provider Demographics
NPI:1487677225
Name:BESHARAT, MOJGAN (OD)
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:
Last Name:BESHARAT
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 1:6910 FAYETTEVILLE ROAD
Mailing Address - Street 2:SUITE 296
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8286
Mailing Address - Country:US
Mailing Address - Phone:919-484-9696
Mailing Address - Fax:
Practice Address - Street 1:6910 FAYETTEVILLE ROAD
Practice Address - Street 2:SUITE 296
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8286
Practice Address - Country:US
Practice Address - Phone:919-484-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093J5OtherBLUE CROSS BLUE SHIELD