Kourosh Farahvashi, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT003050 Issued in GA

Practice address

3159 Highway 278 NE
Covington, GA 30014-2301

Phone

(678) 660-7402

NPI assigned

Apr 5, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• National Vision Inc

  • Optician
  • Covington, GA
  • NPI 1134683600
  NPD (past)

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554422400000",
    "number": "1417419508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9858 NW 42ND CT",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333517694",
            "telephone_number": "954-296-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3159 HIGHWAY 278 NE",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300142301",
            "telephone_number": "678-660-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARAHVASHI",
        "first_name": "KOUROSH",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-05",
        "last_updated": "2019-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Practice & Urgent Care
• Family Practice and Urgent Care
• Family Practice Immediate Care Associate Limited Liability Company
• Valerie Elaine Fanning, DNP
• Sofia Osman Farah
• Vincent Bernard Farrell, FNP-C
• Meridith Farrow, M.D.
• Tyhisha Paden Fashipe, OT
• Lucinda Chappel Faulkner, ARNP
• Priscilla B Faulkner, PSYD

• Optometrist in Covington, GA
• Providers in Covington, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.