Provider Demographics
NPI:1508121815
Name:TAGHAYYOR, SHAHROKH (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAHROKH
Middle Name:
Last Name:TAGHAYYOR
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 1:3268 ROSSBURY CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1819
Mailing Address - Country:US
Mailing Address - Phone:614-218-2907
Mailing Address - Fax:
Practice Address - Street 1:2850 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1723
Practice Address - Country:US
Practice Address - Phone:740-455-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6162T3077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist