MEDICARE: SARA SOLTANMORAD O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12391T	CA

General Provider Information

NPI Number	:	1134211592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA SOLTANMORAD O.D.

Provider Business Mailing Address
First Line	:	37 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4804
Country	:	US
Telephone Number	:	562-436-6739
Fax Number	:	562-432-6957

Provider Business Practice Location Address
First Line	:	37 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4804
Country	:	US
Telephone Number	:	562-436-6739
Fax Number	:	562-432-6957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/22/2016

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