Provider Demographics
NPI:1417967225
Name:MOZAYANI, SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MOZAYANI
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 1:440 IGNACIO BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6037
Mailing Address - Country:US
Mailing Address - Phone:415-883-9888
Mailing Address - Fax:
Practice Address - Street 1:364 IGNACIO BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6037
Practice Address - Country:US
Practice Address - Phone:415-883-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9545152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management