Provider Demographics
NPI:1033319215
Name:ABOUTALEBI-SIMON, SANAZ STACY (OD)
Entity Type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:STACY
Last Name:ABOUTALEBI-SIMON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:ABOUTALEBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2640 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2502
Mailing Address - Country:US
Mailing Address - Phone:925-726-9711
Mailing Address - Fax:
Practice Address - Street 1:3400 DELTA FAIR BLVD
Practice Address - Street 2:THE PERMANENTE MEDICAL GROUP, INC.
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4004
Practice Address - Country:US
Practice Address - Phone:925-779-5223
Practice Address - Fax:925-779-5421
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12259T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU93944Medicare UPIN