Provider Demographics
NPI:1558431866
Name:FARSHID PAYDAR MD PC
Entity Type:Organization
Organization Name:FARSHID PAYDAR MD PC
Other - Org Name:THE EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAENENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-295-7377
Mailing Address - Street 1:401 S CALVARY WAY STE D
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4165
Mailing Address - Country:US
Mailing Address - Phone:928-649-2600
Mailing Address - Fax:928-634-7847
Practice Address - Street 1:2155 W ST RTE 89A STE 106
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5469
Practice Address - Country:US
Practice Address - Phone:928-203-9600
Practice Address - Fax:928-203-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ438540Medicaid
AZ438540Medicaid