Provider Demographics
NPI:1164534780
Name:PAKNEJAD, JANICE SIRIMA (OD)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:SIRIMA
Last Name:PAKNEJAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19038 BRASILIA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1520
Mailing Address - Country:US
Mailing Address - Phone:818-836-2299
Mailing Address - Fax:
Practice Address - Street 1:372 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2725
Practice Address - Country:US
Practice Address - Phone:617-782-6650
Practice Address - Fax:617-782-2660
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12947152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705691OtherMASSHEALTH
MA478947OtherTUFTS
MAW16450OtherBCBS
MA478947OtherTUFTS