Provider Demographics
NPI:1699710988
Name:MOZAFFARIEH, NAZAK (OD)
Entity type:Individual
Prefix:
First Name:NAZAK
Middle Name:
Last Name:MOZAFFARIEH
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 1:1773 SAN PABLO AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2084
Mailing Address - Country:US
Mailing Address - Phone:510-222-3020
Mailing Address - Fax:510-222-9020
Practice Address - Street 1:1773 SAN PABLO AVE STE A1
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2084
Practice Address - Country:US
Practice Address - Phone:510-222-3020
Practice Address - Fax:510-222-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT12430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760878896OtherGROUP NPI