Provider Demographics
NPI:1568706364
Name:DR. SHAD S. SAREMI, O.D., PROF. CORP
Entity Type:Organization
Organization Name:DR. SHAD S. SAREMI, O.D., PROF. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRIYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAREMI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-890-9600
Mailing Address - Street 1:13550 W. PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331
Mailing Address - Country:US
Mailing Address - Phone:818-890-9600
Mailing Address - Fax:818-890-9697
Practice Address - Street 1:13550 W. PAXTON ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331
Practice Address - Country:US
Practice Address - Phone:818-890-9600
Practice Address - Fax:818-890-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12171 TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty