Provider Demographics
NPI:1669795274
Name:NOOSHIN, NEGIN (OD)
Entity type:Individual
Prefix:DR
First Name:NEGIN
Middle Name:
Last Name:NOOSHIN
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 1:9262 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3571
Mailing Address - Country:US
Mailing Address - Phone:210-647-4733
Mailing Address - Fax:210-647-4741
Practice Address - Street 1:9262 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3571
Practice Address - Country:US
Practice Address - Phone:210-647-4733
Practice Address - Fax:210-647-4741
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX7223TG152WC0802X
TX7223TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280291002Medicaid