Provider Demographics
NPI:1053922005
Name:NAZAK MOZAFFARIEH O D INC
Entity type:Organization
Organization Name:NAZAK MOZAFFARIEH O D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZAFFARIEH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-520-3484
Mailing Address - Street 1:1773 SAN PABLO AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2084
Mailing Address - Country:US
Mailing Address - Phone:510-222-3020
Mailing Address - Fax:510-222-9020
Practice Address - Street 1:1773 SAN PABLO AVE STE A1
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2084
Practice Address - Country:US
Practice Address - Phone:510-222-3020
Practice Address - Fax:510-222-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty