Provider Demographics
NPI:1750301560
Name:MAZAHERI, MEHRDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:MAZAHERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:MAZAHERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:670 W CAMPBELL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3393
Mailing Address - Country:US
Mailing Address - Phone:972-889-3937
Mailing Address - Fax:972-889-9155
Practice Address - Street 1:670 W CAMPBELL RD
Practice Address - Street 2:STE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3393
Practice Address - Country:US
Practice Address - Phone:972-889-3937
Practice Address - Fax:972-889-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3330207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP08196559Medicaid
TXP08196559Medicaid
TXG30895Medicare UPIN