=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669795274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEGIN NOOSHIN OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2010
-----------------------------------------------------
Last Update Date | 07/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9262 CULEBRA RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-3571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-647-4733
-----------------------------------------------------
Fax | 210-647-4741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9262 CULEBRA RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-3571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-647-4733
-----------------------------------------------------
Fax | 210-647-4741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | TX7223TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7223TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------