Provider Demographics
NPI:1437232584
Name:LARI, SANDY KASHANI (OPTOMETRIST)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:KASHANI
Last Name:LARI
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11680 MONTANA AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4648
Mailing Address - Country:US
Mailing Address - Phone:310-207-1006
Mailing Address - Fax:
Practice Address - Street 1:1314 WESTWOOD BVLD
Practice Address - Street 2:SUITE # 107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4902
Practice Address - Country:US
Practice Address - Phone:310-234-8790
Practice Address - Fax:310-441-1609
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11437T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist