Provider Demographics
NPI:1467458166
Name:NIAZI, FAY FERESHTEH (DO)
Entity Type:Individual
Prefix:DR
First Name:FAY
Middle Name:FERESHTEH
Last Name:NIAZI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21297 FOOTHILL BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1554
Mailing Address - Country:US
Mailing Address - Phone:510-537-7506
Mailing Address - Fax:510-537-1117
Practice Address - Street 1:21297 FOOTHILL BLVD
Practice Address - Street 2:STE 101
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-1554
Practice Address - Country:US
Practice Address - Phone:510-537-5069
Practice Address - Fax:510-537-1117
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4686-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL953ZMedicare PIN