Provider Demographics
NPI:1760450423
Name:SHAHRIARI, SUSAN (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHAHRIARI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 AUGUSTA DR
Mailing Address - Street 2:SUITE #8
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 NORTH FWY # B
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3604
Practice Address - Country:US
Practice Address - Phone:713-697-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3846T152W00000X
CA9419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11616022OtherCAQH
TX11616022OtherCAQH
TX81443EMedicare PIN