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General NPI Number Information
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NPI Number | 1790222909
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Entity Type | Organization
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Legal Business Name | ROSHANAK NASR O.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 9418 FIRESTONE BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-5504
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Country | US
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Telephone | 562-869-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 9418 FIRESTONE BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-5504
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Country | US
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Telephone | 562-869-3937
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSHANAK NASR
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Credential | OD
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Telephone | 714-606-5505
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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 | 11928TLG
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License Number State | CA
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