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General NPI Number Information
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NPI Number | 1720787070
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Entity Type | Organization
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Legal Business Name | SANA SHAKIL-ANSARI O.D. INC
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 18876 VAN BUREN BLVD # 204
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City | RIVERSIDE
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State | CA
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Zip | 92508-9114
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Country | US
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Telephone | 909-913-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 18876 VAN BUREN BLVD STE 204
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City | RIVERSIDE
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State | CA
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Zip | 92508-9114
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Country | US
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Telephone | 951-498-3937
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SANA SHAKIL-ANSARI
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Credential | DO
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Telephone | 909-913-0005
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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 |
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License Number State |
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