MEDICARE: SAN FERNANDO FAMILY OPTOMETRIC CORPORATION

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

General Provider Information

NPI Number	:	1316899487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN FERNANDO FAMILY OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	1401 21ST ST STE R
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-5226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12920 FOOTHILL BLVD
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-4928
Country	:	US
Telephone Number	:	747-999-3877
Fax Number	:

Authorized Official
Title or Position	:	OD
Name	:	YASAMAN SAKHAKORN
Credential	:
Telephone Number	:	747-999-3877

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/24/2026

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