Provider Demographics
NPI:1831279363
Name:NAMAVARI, ROSHANAK (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:NAMAVARI
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 1:190 E ROUND GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:190 E ROUND GROVE RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8301
Practice Address - Country:US
Practice Address - Phone:469-549-0987
Practice Address - Fax:469-549-0989
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6906TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist