Provider Demographics
NPI:1326190687
Name:HAIIMPOUR, FARSHAD (OD)
Entity type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:HAIIMPOUR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8914 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3715
Mailing Address - Country:US
Mailing Address - Phone:718-739-8939
Mailing Address - Fax:
Practice Address - Street 1:8914 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3715
Practice Address - Country:US
Practice Address - Phone:718-739-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01975960Medicaid
NYP2141131OtherOXFORD
76754121OtherAETNA
76754121OtherAETNA
NY01975960Medicaid