Provider Demographics
NPI:1609108745
Name:VAZIRI, HESSAM
Entity Type:Individual
Prefix:
First Name:HESSAM
Middle Name:
Last Name:VAZIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:HESSAM
Other - Middle Name:
Other - Last Name:VAZIRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:221 TRUMBULL ST
Mailing Address - Street 2:#1808
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1500
Mailing Address - Country:US
Mailing Address - Phone:617-447-5853
Mailing Address - Fax:
Practice Address - Street 1:45 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2208
Practice Address - Country:US
Practice Address - Phone:860-522-2020
Practice Address - Fax:860-522-5577
Is Sole Proprietor?:No
Enumeration Date:2010-01-30
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2825OtherCT LICENSE