MEDICARE: NEGIN NIKAHD OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8272-T	TX
2	152W00000X	Optometrist	14673 TLG	CA

General Provider Information

NPI Number	:	1093154932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEGIN NIKAHD OD

Provider Business Mailing Address
First Line	:	19636 SHERMAN WAY
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3647
Country	:	US
Telephone Number	:	713-376-2771
Fax Number	:

Provider Business Practice Location Address
First Line	:	19636 SHERMAN WAY
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3647
Country	:	US
Telephone Number	:	713-376-2771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	12/27/2021

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Directions to “ NEGIN NIKAHD OD” Practice Location

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