Provider Demographics
NPI:1598014557
Name:HOSSEINI-MODARRES, MAHSA (OD)
Entity Type:Individual
Prefix:DR
First Name:MAHSA
Middle Name:
Last Name:HOSSEINI-MODARRES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MAHSA
Other - Middle Name:
Other - Last Name:MODARES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:9 N VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5410
Mailing Address - Country:US
Mailing Address - Phone:954-560-6983
Mailing Address - Fax:
Practice Address - Street 1:9 N VALENCIA DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5410
Practice Address - Country:US
Practice Address - Phone:954-560-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist