Mohammad Tamim Mukhtarzada, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG003539 Issued in PA

Practice address

3060 Center Valley Pkwy Ste 822
Center Valley, PA 18034-9040

Phone

(610) 791-0672

NPI assigned

Jun 25, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Visionworks, Inc.

  • Optometrist
  • Erie, PA
  • NPI 1063579837
  Medicare reassignment NPD
• Visionworks, Inc

  • Eyewear Supplier
  • Simpsonville, SC
  • NPI 1699571166
  NPD
• Luxottica of America Inc.

  • Eyewear Supplier
  • Center Valley, PA
  • NPI 1255412003
  NPD (past)
• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729987200000",
    "number": "1164083697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 SUNRISE HWY",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117414801",
            "telephone_number": "631-244-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 CENTER VALLEY PKWY STE 822",
            "city": "CENTER VALLEY",
            "state": "PA",
            "postal_code": "180349040",
            "telephone_number": "610-791-0672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKHTARZADA",
        "first_name": "MOHAMMAD",
        "middle_name": "TAMIM",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-25",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "ORT009480",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret L Mitchell
• Patricia G Modestino, FNP
• Susan Dianne Mondaca, NCC, LPC
• Nichole Lynn Morrison, CRNP
• Catherine B Morrow, CRNP
• Katherine L Muller, PSYD
• Shawna Murphy, DO
• Myeyedr Optometry of Pennsylvania, LLC
• Courtney Ann Nace, NP
• Gaurav Nagar, MD

• Optometrist in Center Valley, PA
• Providers in Center Valley, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.