Provider Demographics
NPI:1154514495
Name:PAVER, MOUSAMI (OD)
Entity type:Individual
Prefix:DR
First Name:MOUSAMI
Middle Name:
Last Name:PAVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3971 IRVINE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2482
Mailing Address - Country:US
Mailing Address - Phone:714-505-0555
Mailing Address - Fax:714-505-2655
Practice Address - Street 1:3971 IRVINE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2482
Practice Address - Country:US
Practice Address - Phone:714-505-0555
Practice Address - Fax:714-505-2655
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00587800152W00000X
CA15073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist