Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 5064TG | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5064TG | TX |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 5064TG | TX |
N | 152WP0200X | Pediatric Optomitrist | 5064TG | TX |
N | 152WS0006X | Sports Vision | 5064TG | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 5064TG | TX |
N | 152WX0102X | Occupational Vision | 5064TG | TX |
NPI | 1003822834 |
---|---|
Provider Name | Dr. Saadi Marco Darvish |
First Address | Plano, TX 75093-4451 |
Second Address | Plano, TX 75093-4451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80582Q | BLUE CROSS BLUE SHIELD ID (01) | TX |
U83363 | (02) | TX |