Provider Demographics
NPI:1487719274
Name:ROUHANI, LADAN MOHTADI (OD)
Entity type:Individual
Prefix:
First Name:LADAN
Middle Name:MOHTADI
Last Name:ROUHANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LADAN
Other - Middle Name:CHARLENE
Other - Last Name:MOHTADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8380 WARREN PKWY
Mailing Address - Street 2:STE 605
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8380 WARREN PKWY
Practice Address - Street 2:STE 605
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4253
Practice Address - Country:US
Practice Address - Phone:972-668-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8377T152W00000X
CA12618T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0126180Medicare PIN
CAV05690Medicare UPIN
CA1292250001Medicare NSC