| Doctor Name: | SOROUSH BAHNAMIRI AZADI |
| NPI Number: | 1003825621 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | O.D. |
| License Number: | 6642TG |
| Business Practice Address: | 4211 S Lamar Blvd Ste E-3 Austin, TX - 787047996 |
| Business Phone Number: | 5129164600 |
| Business Fax Number: | |
| Mailing Address: | 4211 S Lamar Blvd, Ste E-3 AUSTIN |
| State: | TX |
| Postal Code: | 787047996 |
| Phone Number: | 5129164600 |
| Fax Number: | |
| NPI Enumeration Date: | 08/05/2006 |
| NPI Last Update Date: | 09/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 6642TG |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |