MEDICARE: DR. MAZEYAR SABOORI M.D.

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	207W00000X	Ophthalmology Physician	17007	NV
2	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	17007	NV

General Provider Information

NPI Number	:	1487914099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAZEYAR SABOORI M.D.

Provider Business Mailing Address
First Line	:	20800 HARVARD RD
Second Line	:	2ND FLOOR
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5556 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7696
Country	:	US
Telephone Number	:	702-358-0472
Fax Number	:	702-425-9955

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

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	07/30/2020

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