Provider Demographics
NPI:1275582421
Name:NARAYAN, SASHA NIRANJALI (OD)
Entity Type:Individual
Prefix:DR
First Name:SASHA
Middle Name:NIRANJALI
Last Name:NARAYAN
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 1:1010 22ND ST
Mailing Address - Street 2:APT 301
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2876
Mailing Address - Country:US
Mailing Address - Phone:773-495-9669
Mailing Address - Fax:
Practice Address - Street 1:1001 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1617
Practice Address - Country:US
Practice Address - Phone:773-495-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMN2979OtherEYE MED
MN22-03363OtherMEDICA CLOQUET
MN2203364OtherMEDICA VIRGINIA
MN490P1NAOtherBCBS OF MN
MNB25741047253OtherPREFERRED ONE
MNV07438Medicare UPIN