Provider Demographics
NPI:1730442435
Name:POURSHAHRIARI, SAHAR (OD)
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:POURSHAHRIARI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-0468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:482 NORRISTOWN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2349
Practice Address - Country:US
Practice Address - Phone:610-956-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist