Provider Demographics
NPI:1770907966
Name:KIARASH BASSIRI, OD, PA
Entity type:Organization
Organization Name:KIARASH BASSIRI, 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:919-977-7480
Mailing Address - Street 1:6400 CREEDMOOR RD STE 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4482
Mailing Address - Country:US
Mailing Address - Phone:919-977-7480
Mailing Address - Fax:919-977-7481
Practice Address - Street 1:6400 CREEDMOOR RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3600
Practice Address - Country:US
Practice Address - Phone:919-977-7480
Practice Address - Fax:919-977-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2055152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty