Provider Demographics
NPI:1598952681
Name:BASSIRI, KIARASH (OD)
Entity Type:Individual
Prefix:DR
First Name:KIARASH
Middle Name:
Last Name:BASSIRI
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 1:6400 CREEDMOOR RD
Mailing Address - Street 2:#103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4481
Mailing Address - Country:US
Mailing Address - Phone:919-977-7480
Mailing Address - Fax:919-977-7481
Practice Address - Street 1:6400 CREEDMOOR RD
Practice Address - Street 2:#103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4481
Practice Address - Country:US
Practice Address - Phone:919-977-7480
Practice Address - Fax:919-977-7481
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2055152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC261237875OtherTRICARE
NC48238OtherOPTUM HEALTH
NC3904051OtherCIGNA
NC827989OtherWELLPATH
NC093XPOtherBCBS
NC36893OtherAVESIS
NC5912605Medicaid
NC00011136OtherADVANTICA
NC29892OtherMES VISION
NC9160113OtherAETNA
NC935814OtherBLOCK VISION
NC261237875OtherNVA
NC58392OtherDAVIS VISION
NC3904051OtherCIGNA