Healthcare Provider Details

I. General information

NPI: 1114597234
Provider Name (Legal Business Name): ARZOO WASTANI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19210 GULF FWY
FRIENDSWOOD TX
77546-2705
US

IV. Provider business mailing address

1825 SAN JACINTO ST UNIT 413
HOUSTON TX
77002-8253
US

V. Phone/Fax

Practice location:
  • Phone: 832-224-4766
  • Fax:
Mailing address:
  • Phone: 214-436-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10295T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: