1265604623 NPI number — BASSIRI EYE CARE OD, PA

Table of content: (NPI 1265604623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265604623 NPI number — BASSIRI EYE CARE OD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASSIRI EYE CARE OD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RALEIGH VISION O.D., PLLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265604623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 GLENWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27612-7128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-784-8100
Provider Business Mailing Address Fax Number:
919-784-8600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 GLENWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27612-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-784-8100
Provider Business Practice Location Address Fax Number:
919-784-8600
Provider Enumeration Date:
03/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BASSIRI
Authorized Official First Name:
KIARASH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-784-8100

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2055 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5912605 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00011136 . This is a "ADVANTICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58392 . This is a "DAVIS VISION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 48238 . This is a "SPECTERA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3904051 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9160113 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 093XP . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 29892 . This is a "MES VISION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 935814 . This is a "BLOCK VISION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 36893 . This is a "AVESIS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 48238 . This is a "OPTUM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 827989 . This is a "WELLPATH" identifier . This identifiers is of the category "OTHER".




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