Provider Demographics
NPI:1164662268
Name:SANDRA D FARHADY ODPA
Entity type:Organization
Organization Name:SANDRA D FARHADY ODPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARHADY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-983-1783
Mailing Address - Street 1:4831 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5834
Mailing Address - Country:US
Mailing Address - Phone:954-983-1783
Mailing Address - Fax:954-983-3179
Practice Address - Street 1:7183 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33023-2626
Practice Address - Country:US
Practice Address - Phone:954-981-5455
Practice Address - Fax:954-981-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty