MEDICARE: DR. SHAHROKH DAYYANI 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	152WC0802X	Corneal and Contact Management Optometrist	T10307	CA
2	152WL0500X	Low Vision Rehabilitation Optometrist	T10307	CA
3	152WP0200X	Pediatric Optometrist	T10307	CA
4	152W00000X	Optometrist	T10307	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194893008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHROKH DAYYANI O.D.

Provider Business Mailing Address
First Line	:	2635 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2401
Country	:	US
Telephone Number	:	310-319-6122
Fax Number	:	213-378-2716

Provider Business Practice Location Address
First Line	:	2635 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2401
Country	:	US
Telephone Number	:	310-319-6122
Fax Number	:	310-458-4799

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/20/2023

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Directions to “ DR. SHAHROKH DAYYANI O.D.” Practice Location

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