Provider Demographics
NPI:1063583581
Name:TEHRANI, CAROLYN (OD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TEHRANI
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 1:119 15 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:718-805-0700
Mailing Address - Fax:718-805-5621
Practice Address - Street 1:119 15 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-805-0700
Practice Address - Fax:718-805-5621
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007030207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC512E1Medicare PIN
NY00815PMedicare PIN