Provider Demographics
NPI:1821655994
Name:ZEINALPOUR, LIDA (OD)
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:
Last Name:ZEINALPOUR
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 1:8140 NORTON PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6017
Mailing Address - Country:US
Mailing Address - Phone:440-255-1115
Mailing Address - Fax:
Practice Address - Street 1:9485 MENTOR AVE STE 110
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8724
Practice Address - Country:US
Practice Address - Phone:440-255-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist