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General NPI Number Information
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NPI Number | 1730389891
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Entity Type | Organization
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Legal Business Name | SELIN KHAYATAN OD INC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 3580 BLACKHAWK PLAZA CIR
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City | DANVILLE
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State | CA
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Zip | 94506-4611
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Country | US
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Telephone | 925-648-4188
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 GENOA ST
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City | DANVILLE
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State | CA
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Zip | 94506-1919
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Country | US
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Telephone | 925-648-4188
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SELIN KHAYATAN
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Credential | O.D.
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Telephone | 925-648-4188
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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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