Provider Demographics
NPI:1477127249
Name:YAZDAN, SHAHRZAD (OD)
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:YAZDAN
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 1:30505 AVENIDA DE LAS FLORES STE A
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3939
Mailing Address - Country:US
Mailing Address - Phone:949-459-1063
Mailing Address - Fax:
Practice Address - Street 1:30505 AVENIDA DE LAS FLORES STE A
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3939
Practice Address - Country:US
Practice Address - Phone:949-742-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34815TLG152W00000X
CA34815152WC0802X, 152W00000X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy