Provider Demographics
NPI:1710092309
Name:MAZHARI, NIMA (OD)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:MAZHARI
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 1:1091 CURRITUCK WAY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-2887
Mailing Address - Country:US
Mailing Address - Phone:803-628-8762
Mailing Address - Fax:
Practice Address - Street 1:2325 ABERDEEN BLVD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0642
Practice Address - Country:US
Practice Address - Phone:704-853-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1448152W00000X, 152W00000X
NC2032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710092309OtherINDIVIDUAL NPI
1710092309OtherINDIVIDUAL NPI
1437370657OtherFACILITY NPI