# DR. HASSAN TAVAKKOLI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1932380441
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | OS 6626 | FL | Yes |

## Other

- **Enumeration date:** 11/27/2007
- **Last updated:** 03/23/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0853300 | AETNA | FL |
| 01 | — | 235914 | AVMED | FL |
| 01 | — | 375397200 | MEDICAID | FL |
| 05 | — | 375397200 | — | FL |
| 01 | — | 650505235 | UNITEDHEALTHCARE | FL |
| 01 | — | 80799 | BLUE CROSS BLUE SHIELD | FL |