Provider Demographics
NPI:1912986134
Name:ROUHI, MOOJAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MOOJAN
Middle Name:
Last Name:ROUHI
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 1:65 HUTCHINS RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1027
Mailing Address - Country:US
Mailing Address - Phone:978-371-8026
Mailing Address - Fax:978-686-0682
Practice Address - Street 1:65 HUTCHINS RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:MA
Practice Address - Zip Code:01741-1027
Practice Address - Country:US
Practice Address - Phone:978-371-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0371980Medicaid
MAW15831OtherBLUE CROSS BLUE SHIELD
MA0371980Medicaid