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General NPI Number Information
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NPI Number | 1104352806
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Entity Type | Organization
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Legal Business Name | NIKKI IRAVANI OD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 2702 AUGUSTINE DR STE 120
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City | SANTA CLARA
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State | CA
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Zip | 95054-2940
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Country | US
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Telephone | 408-528-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 AUGUSTINE DR STE 120
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City | SANTA CLARA
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State | CA
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Zip | 95054-2940
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Country | US
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Telephone | 408-528-7100
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. NIKOO IRAVANI
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Credential | O.D.
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Telephone | 408-528-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9985T
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License Number State | CA
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