Provider Demographics
NPI:1568512184
Name:LESSANI, FARIBA (OD)
Entity Type:Individual
Prefix:
First Name:FARIBA
Middle Name:
Last Name:LESSANI
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 1:1762 HERON AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4812
Mailing Address - Country:US
Mailing Address - Phone:408-425-5560
Mailing Address - Fax:
Practice Address - Street 1:3130 ALPINE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7549
Practice Address - Country:US
Practice Address - Phone:650-391-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU82449Medicare UPIN
CADU074AMedicare PIN