Provider Demographics
NPI:1154478899
Name:NOORY, FARAH N (OD)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:N
Last Name:NOORY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 MACQUIRE WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:925-895-9093
Mailing Address - Fax:
Practice Address - Street 1:2260 GLADSTONE DR STE 4
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5125
Practice Address - Country:US
Practice Address - Phone:925-432-9300
Practice Address - Fax:925-432-9600
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88482Medicare UPIN
CASD0114830Medicare ID - Type Unspecified