=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700537644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHENILA RAJANI OD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2022
-----------------------------------------------------
Last Update Date | 06/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3471 WEST CENTURY BLVD C/O TARGET OPTICAL
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-330-0180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1430 19TH ST
-----------------------------------------------------
City | MANHATTAN BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90266-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-343-9322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. SHENILA RAJANI
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 310-343-9322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------