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General NPI Number Information
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NPI Number | 1104947936
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Entity Type | Individual
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Provider Name | SASHA PENN O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 3945 PIEDMONT AVE
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City | OAKLAND
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State | CA
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Zip | 94611-5351
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Country | US
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Telephone | 510-654-4747
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Fax | 510-654-0419
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Provider Business Mailing Address
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Address Line | 1945 17TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-1243
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Country | US
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Telephone | 415-260-6321
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Fax | 415-276-6049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12051T
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License Number State | CA
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