Provider Demographics
NPI:1740513803
Name:QAZI, SAMIRA F (OD)
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:F
Last Name:QAZI
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 1:5730 BOTTINEAU BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3181
Mailing Address - Country:US
Mailing Address - Phone:763-537-3213
Mailing Address - Fax:763-537-6732
Practice Address - Street 1:5730 BOTTINEAU BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3181
Practice Address - Country:US
Practice Address - Phone:763-537-3213
Practice Address - Fax:763-537-6732
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3992152W00000X
CA14304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0930WOtherBLUE CROSS
NC5914396Medicaid
NC5914396Medicaid