=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598058729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARHI EYE CARE & SURGERY SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2011
-----------------------------------------------------
Last Update Date | 05/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 S MAIN ST UNIT 1
-----------------------------------------------------
City | BLACKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24060-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-651-1058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 WALLACE RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15209-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-651-1058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | PARISA FARHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-651-1058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 0101249446
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------