Healthcare Provider Details

I. General information

NPI: 1811835150
Provider Name (Legal Business Name): MANSOOR SHAFQAT ABOC, NCLEC, LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVE
DAVIS CA
95616-8500
US

IV. Provider business mailing address

907 BOURN DR SPC 24
WOODLAND CA
95776-9304
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-3324
  • Fax: 530-752-4252
Mailing address:
  • Phone: 530-752-3324
  • Fax: 530-752-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number2265
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number6053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: