Provider Demographics
NPI:1023458015
Name:MOMENI, PONTEA AZANDARYANI (OD)
Entity type:Individual
Prefix:
First Name:PONTEA
Middle Name:AZANDARYANI
Last Name:MOMENI
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 1:3100 WESLAYAN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5727
Mailing Address - Country:US
Mailing Address - Phone:713-526-1600
Mailing Address - Fax:713-620-7697
Practice Address - Street 1:3100 WESLAYAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5727
Practice Address - Country:US
Practice Address - Phone:713-526-1600
Practice Address - Fax:713-620-7697
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8228T152W00000X
TX8228TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303927YNEWMedicare PIN
TX303927YT4MMedicare PIN
TX303927YT4LMedicare PIN