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General NPI Number Information
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NPI Number | 1184764011
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Entity Type | Individual
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Provider Name | SARA FARNAZ TAVASSOLI O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 288 N SANTA ANITA AVE STE 103
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City | ARCADIA
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State | CA
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Zip | 91006-3183
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Country | US
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Telephone | 626-829-8185
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Fax | 626-829-8186
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Provider Business Mailing Address
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Address Line | 24662 EL MANZANO
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7637
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Country | US
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Telephone | 301-538-0032
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Fax | 240-328-6311
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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 | TA 1989
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT13395TPL
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License Number State | CA
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