Healthcare Provider Details

I. General information

NPI: 1003822834
Provider Name (Legal Business Name): SAADI MARCO DARVISH O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 FORRESTER DR SE
DAWSON GA
39842-2006
US

IV. Provider business mailing address

1208 VILLAGE CREEK DR SUITE 104
PLANO TX
75093-4451
US

V. Phone/Fax

Practice location:
  • Phone: 229-995-2990
  • Fax:
Mailing address:
  • Phone: 972-931-1133
  • Fax: 972-931-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001378
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1207
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003773
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5064TG
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5064TG
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5064TG
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number5064TG
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number5064TG
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number5064TG
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number5064TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: