Provider Demographics
NPI:1528830262
Name:SHAHRZAD YAZDAN OD INC
Entity type:Organization
Organization Name:SHAHRZAD YAZDAN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-742-9594
Mailing Address - Street 1:7725 GATEWAY UNIT 1340
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1578
Mailing Address - Country:US
Mailing Address - Phone:949-742-9594
Mailing Address - Fax:
Practice Address - Street 1:30505 AVENIDA DE LAS FLORES STE A
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3939
Practice Address - Country:US
Practice Address - Phone:949-459-1063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty