Healthcare Provider Details

I. General information

NPI: 1730896028
Provider Name (Legal Business Name): VISION NEUROLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 GEARY BLVD STE 210
SAN FRANCISCO CA
94115-3456
US

IV. Provider business mailing address

2186 GEARY BLVD STE 210
SAN FRANCISCO CA
94115-2855
US

V. Phone/Fax

Practice location:
  • Phone: 415-800-4178
  • Fax: 415-800-4942
Mailing address:
  • Phone: 415-800-4178
  • Fax: 415-800-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHNAZ MIRI
Title or Position: CEO
Credential: MD, MBA
Phone: 415-800-4178