Healthcare Provider Details

I. General information

NPI: 1487914099
Provider Name (Legal Business Name): MAZEYAR SABOORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5556 S FORT APACHE RD
LAS VEGAS NV
89148-7696
US

IV. Provider business mailing address

20800 HARVARD RD 2ND FLOOR
HIGHLAND HILLS OH
44122-7251
US

V. Phone/Fax

Practice location:
  • Phone: 702-358-0472
  • Fax: 702-425-9955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17007
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number17007
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: