Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT-002336 | AZ |
NPI | 1013579473 |
---|---|
Provider Name | Kiyavash Tebyanian |
First Address | Scottsdale, AZ 85260-2603 |
Second Address | Scottsdale, AZ 85260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 15/08/2019 |