MEDICARE: DR. SAIED REZA HASHEMI O.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	152WC0802X	Corneal and Contact Management Optometrist	6675TG	TX
2	152WS0006X	Sports Vision Optometrist	6675TG	TX

General Provider Information

NPI Number	:	1861580243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAIED REZA HASHEMI O.D.

Provider Business Mailing Address
First Line	:	4691 SH 121 STE 700
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75056-4112
Country	:	US
Telephone Number	:	972-370-3937
Fax Number	:	972-370-3937

Provider Business Practice Location Address
First Line	:	4691 SH 121
Second Line	:	STE#700
City	:	LEWISVILLE
State	:	TX
Zip	:	75056-4010
Country	:	US
Telephone Number	:	214-534-3030
Fax Number	:	214-469-1212

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	11/03/2021

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