MEDICARE: DR. IFRAH SHEESFAROOQUI O.D.

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	2097	AZ
2	152W00000X	Optometrist	OPT33572 TLG	CA

General Provider Information

NPI Number	:	1467833905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFRAH SHEESFAROOQUI O.D.

Provider Business Mailing Address
First Line	:	1142 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3538
Country	:	US
Telephone Number	:	310-323-5095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1142 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3538
Country	:	US
Telephone Number	:	310-323-5095
Fax Number	:

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

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	01/20/2023

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