Most Relevant Information
Provider Data
| NPI Number: | 1003825621 |
| Provider Name: | SOROUSH BAHNAMIRI AZADI O.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 152WC0802X |
| Specialty: | Optometrist |
| License Number: | 6642TG |
Most Important Dates
| Enumeration Date: | 08/05/2006 |
| Last Updated: | 09/12/2012 |
Provider Practice Location
4211 S LAMAR BLVD
STE E-3
AUSTIN
TX
787047996
Practice Location Phone/Fax
| Phone: | 5129164600 |
| Fax: |
Provider Mailing Location
4211 S LAMAR BLVD
STE E-3
AUSTIN
TX
787047996
Provider Mailing Phone/Fax
| Phone: | 5129164600 |
| Fax: |