MEDICARE: MRS. SANDY KASHANI LARI OPTOMETRIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11437T	CA

General Provider Information

NPI Number	:	1437232584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDY KASHANI LARI OPTOMETRIST

Provider Business Mailing Address
First Line	:	11680 MONTANA AVE APT 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4648
Country	:	US
Telephone Number	:	310-207-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 WESTWOOD BVLD
Second Line	:	SUITE # 107
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4902
Country	:	US
Telephone Number	:	310-234-8790
Fax Number	:	310-441-1609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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