MEDICARE: ZEEST PERVAIZ O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001305	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2368327000	OTHER	PA	IBC

General Provider Information

NPI Number	:	1699770420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZEEST PERVAIZ O.D.

Provider Business Mailing Address
First Line	:	3600 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2641
Country	:	US
Telephone Number	:	215-387-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2641
Country	:	US
Telephone Number	:	215-387-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/12/2009

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Directions to “ ZEEST PERVAIZ O.D.” Practice Location

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