Healthcare Provider Details

I. General information

NPI: 1083685234
Provider Name (Legal Business Name): BOYD VAZIRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9617 GULF RESEARCH LN
FORT MYERS FL
33912-4555
US

IV. Provider business mailing address

9617 GULF RESEARCH LN
FORT MYERS FL
33912-4555
US

V. Phone/Fax

Practice location:
  • Phone: 239-418-0999
  • Fax: 239-274-0773
Mailing address:
  • Phone: 239-418-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2005-00860
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: