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General NPI Number Information
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NPI Number | 1801024716
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Entity Type | Individual
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Provider Name | SAMIN PEZESHK O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 4553 N LOOP 1604 W STE 1225
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City | SAN ANTONIO
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State | TX
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Zip | 78249-1365
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Country | US
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Telephone | 210-251-2372
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Fax | 210-251-2231
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8342-T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003589A
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License Number State | IN
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