Provider Demographics
NPI:1992020267
Name:FAZLALIZADEH, ALNAZ (OD)
Entity Type:Individual
Prefix:DR
First Name:ALNAZ
Middle Name:
Last Name:FAZLALIZADEH
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 1:19752 NORTH FWY
Mailing Address - Street 2:SUITE B.
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-5301
Mailing Address - Country:US
Mailing Address - Phone:281-288-7026
Mailing Address - Fax:281-288-7028
Practice Address - Street 1:19752 NORTH FWY
Practice Address - Street 2:SUITE B
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-5301
Practice Address - Country:US
Practice Address - Phone:281-288-7026
Practice Address - Fax:281-288-7028
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7443TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist