Provider Demographics
NPI:1831279363
Name:NAMAVARI, ROSHANAK (OD)
Entity type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:NAMAVARI
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 1:3341 REGENT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3131
Mailing Address - Country:US
Mailing Address - Phone:972-910-8829
Mailing Address - Fax:
Practice Address - Street 1:3341 REGENT BLVD STE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3131
Practice Address - Country:US
Practice Address - Phone:972-910-8829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6906TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist