Healthcare Provider Details

I. General information

NPI: 1477600856
Provider Name (Legal Business Name): NIKI FORGHANI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LENNON LN
WALNUT CREEK CA
94598-2419
US

IV. Provider business mailing address

320 LENNON LN
WALNUT CREEK CA
94598-2419
US

V. Phone/Fax

Practice location:
  • Phone: 925-906-2045
  • Fax: 925-906-2360
Mailing address:
  • Phone: 925-906-2045
  • Fax: 925-906-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11130T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: