MEDICARE: DAN ROD OPTOMETRIC CENTER INC

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	:	1346020351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAN ROD OPTOMETRIC CENTER INC

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	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAHROKH DAYYANI
Credential	:	OD
Telephone Number	:	310-319-6122

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	10/05/2023

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Directions to “DAN ROD OPTOMETRIC CENTER INC ” Practice Location

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