Healthcare Provider Details

I. General information

NPI: 1639012917
Provider Name (Legal Business Name): ZOHREH SAFFARI STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NEWBURY AVE
QUINCY MA
02171-1919
US

IV. Provider business mailing address

424 BEACON ST
BOSTON MA
02115-1129
US

V. Phone/Fax

Practice location:
  • Phone: 918-904-0329
  • Fax:
Mailing address:
  • Phone: 617-266-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: