Provider Demographics
NPI:1679142244
Name:VARASTEH, NEDA (OD)
Entity type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:VARASTEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NEDA
Other - Middle Name:
Other - Last Name:NOROUZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1615 S CONGRESS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1615 S CONGRESS AVE STE 105
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6326
Practice Address - Country:US
Practice Address - Phone:561-208-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOPT2395152W00000X
TNOPT3859152W00000X
GAOPT003319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty