Provider Demographics
NPI:1922060706
Name:SHAHIDZADEH, ANISAH PRUEITT (OD)
Entity Type:Individual
Prefix:DR
First Name:ANISAH
Middle Name:PRUEITT
Last Name:SHAHIDZADEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4543 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2623
Mailing Address - Country:US
Mailing Address - Phone:214-794-9080
Mailing Address - Fax:940-497-4981
Practice Address - Street 1:3901 FM 2181
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-4250
Practice Address - Country:US
Practice Address - Phone:940-497-4971
Practice Address - Fax:940-497-4981
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6620TG152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics