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General NPI Number Information
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NPI Number | 1265604623
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Entity Type | Organization
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Legal Business Name | BASSIRI EYE CARE OD, PA
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 6600 GLENWOOD AVE
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City | RALEIGH
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State | NC
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Zip | 27612-7128
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Country | US
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Telephone | 919-784-8100
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Fax | 919-784-8600
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Provider Business Mailing Address
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Address Line | 6600 GLENWOOD AVE
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City | RALEIGH
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State | NC
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Zip | 27612-7128
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Country | US
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Telephone | 919-784-8100
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Fax | 919-784-8600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIARASH BASSIRI
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Credential | O.D.
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Telephone | 919-784-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2055
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License Number State | NC
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