MEDICARE: RAMIN ANTHONY RABBANI

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	11736T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1760491948	OTHER	CA	PERSONAL NPI #

General Provider Information

NPI Number	:	1841402484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMIN ANTHONY RABBANI

Provider Business Mailing Address
First Line	:	10718 RIVERSIDE DR
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2313
Country	:	US
Telephone Number	:	818-985-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	10718 RIVERSIDE DR
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2313
Country	:	US
Telephone Number	:	818-985-3937
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST AND OWNER
Name	:	DR. RAMIN ANTHONY RABBANI
Credential	:	OD
Telephone Number	:	818-985-3937

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/30/2008

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