Moussa Omidvar, is a medicare enrolled "Radiology - Vascular & Interventional Radiology" physician in Lebanon, Oregon. His current practice location is
200 Mullins Dr, Lebanon, Oregon. You can reach out to his office (for appointments etc.) via phone at
(541) 259-0200.
Moussa Omidvar is licensed to practice in Texas (license number W8603) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1639672678.
Physician's Profile
| Full Name | Moussa Omidvar |
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| Gender | Male |
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| Speciality | Radiology - Vascular & Interventional Radiology |
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| Location | 200 Mullins Dr, Lebanon, Oregon |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1639672678
- Provider Enumeration Date: 03/15/2018
- Last Update Date: 08/19/2026
Medicare PECOS Information:
- PECOS PAC ID: 7012339864
- Enrollment ID: I20200624000604
Medical Identifiers
Medical identifiers for Moussa Omidvar such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1639672678 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 2085R0204X | Radiology - Vascular & Interventional Radiology | W8603 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Moussa Omidvar is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Moussa Omidvar, 120 E Harris Ave, San Angelo, TX 76903-5904 Ph: (325) 747-6741 | Moussa Omidvar, 200 Mullins Dr, Lebanon, OR 97355-3983 Ph: (541) 259-0200 |
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