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General NPI Number Information
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NPI Number | 1518324334
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Entity Type | Organization
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Legal Business Name | NILOUFAR HEDAYAT, O.D., INC.
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 27702 CROWN VALLEY PKWY SUITE A-3
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City | LADERA RANCH
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State | CA
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Zip | 92694-0608
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Country | US
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Telephone | 949-429-3333
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Fax | 949-429-3334
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Provider Business Mailing Address
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Address Line | 27702 CROWN VALLEY PKWY SUITE A-3
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City | LADERA RANCH
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State | CA
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Zip | 92694-0608
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Country | US
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Telephone | 949-429-3333
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Fax | 949-429-3334
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Authorized Official
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Title or Position | OWNER / DIRECTOR
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Name | NILOUFAR HEDAYAT
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Credential | O.D.
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Telephone | 949-429-3333
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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 | 13497
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License Number State | CA
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