Samin Pezeshk, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

8342-T Issued in TX

Practice address

4553 N Loop 1604 W Ste 1225
San Antonio, TX 78249-1365

Phone

(210) 251-2372

Fax

(210) 251-2231

NPI assigned

Jun 30, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• San Antonio Eyeworks PLLC

  • Clinic/Center
  • San Antonio, TX
  • NPI 1780050286

  Optometrist, TX

  Medicare reassignment NPD Authorized official
• Midwest Eye Consultants, P.C.

  • Optometrist
  • Greensburg, IN
  • NPI 1013480482
  NPD (past)

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1801024716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4553 N LOOP 1604 W STE 1225",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782491365",
            "telephone_number": "210-251-2372",
            "fax_number": "210-251-2231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZESHK",
        "first_name": "SAMIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-30",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8342-T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003589A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200953050",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Petty
• Edward Walter Pettyjohn, M.D.
• Hazel Pevehouse
• Cody Joel Pewarchuk, DMD
• Larissa Pexton
• Alizay Ravae Pezza
• Kimberlee Pfaff, CPO
• Jennifer Pfeffer
• Judith Katherine Pfeifer, M.S. , LPC
• Priscilla Christine Pfeifer, LCSW, LAC

• All providers in San Antonio, TX
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.