Provider Demographics
NPI:1265604623
Name:BASSIRI EYE CARE OD, PA
Entity type:Organization
Organization Name:BASSIRI EYE CARE OD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-784-8100
Mailing Address - Street 1:6600 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7128
Mailing Address - Country:US
Mailing Address - Phone:919-784-8100
Mailing Address - Fax:919-784-8600
Practice Address - Street 1:6600 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7128
Practice Address - Country:US
Practice Address - Phone:919-784-8100
Practice Address - Fax:919-784-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912605Medicaid
00011136OtherADVANTICA
NC58392OtherDAVIS VISION
NC48238OtherSPECTERA
3904051OtherCIGNA
9160113OtherAETNA
NC093XPOtherBCBS
NC29892OtherMES VISION
NC935814OtherBLOCK VISION
NC36893OtherAVESIS
48238OtherOPTUM HEALTH
827989OtherWELLPATH
3904051OtherCIGNA
NC=========OtherTRICARE
NC=========OtherTRICARE