Provider Demographics
NPI:1942361290
Name:MOMAYEZZADEH, PANTA A (OD)
Entity Type:Individual
Prefix:DR
First Name:PANTA
Middle Name:A
Last Name:MOMAYEZZADEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PANTA
Other - Middle Name:
Other - Last Name:ATAROD-ZADEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3542 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-441-0533
Mailing Address - Fax:305-441-0543
Practice Address - Street 1:3542 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-441-0533
Practice Address - Fax:305-441-0543
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist