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General NPI Number Information
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NPI Number | 1811017320
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Entity Type | Individual
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Provider Name | SHASA DABNER O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7629 MELROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90046-7419
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Country | US
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Telephone | 323-651-5646
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Fax |
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Provider Business Mailing Address
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Address Line | 11536 BURBANK BLVD UNIT 101
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City | N HOLLYWOOD
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State | CA
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Zip | 91601-2333
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11850T
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License Number State | CA
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