Provider Demographics
NPI:1689617862
Name:BAGHERI, ZAHRA (OD)
Entity Type:Individual
Prefix:MRS
First Name:ZAHRA
Middle Name:
Last Name:BAGHERI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:ZAHRA
Other - Middle Name:
Other - Last Name:BAGHERI-DJONDABEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2879 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2023
Mailing Address - Country:US
Mailing Address - Phone:901-458-4580
Mailing Address - Fax:901-458-0020
Practice Address - Street 1:2879 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2023
Practice Address - Country:US
Practice Address - Phone:901-458-4580
Practice Address - Fax:901-458-0020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist