Individual
SAMIRA SADAT MORTAZAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
243 CHARLES ST, BOSTON, MA 02114-3096
(617) 573-4177
Mailing address
243 CHARLES ST, BOSTON, MA 02114-3096
(617) 573-4177
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5631
MA
Other
Enumeration date
06/22/2022
Last updated
08/08/2023
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