Provider Demographics
NPI:1437465747
Name:AZADI OPTOMETRIC SERVICES PLLC
Entity type:Organization
Organization Name:AZADI OPTOMETRIC SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOROUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZADI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-650-3092
Mailing Address - Street 1:1311 FAIRWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722
Mailing Address - Country:US
Mailing Address - Phone:512-650-3092
Mailing Address - Fax:512-777-5030
Practice Address - Street 1:1311 FAIRWOOD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1023
Practice Address - Country:US
Practice Address - Phone:512-650-3092
Practice Address - Fax:512-777-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6642TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty