Provider Demographics
NPI:1609242692
Name:PAYAM ZAREHBIN
Entity Type:Organization
Organization Name:PAYAM ZAREHBIN
Other - Org Name:FRUITVALE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAREHBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-292-9067
Mailing Address - Street 1:3301 E 12TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3424
Mailing Address - Country:US
Mailing Address - Phone:510-533-6567
Mailing Address - Fax:510-533-6566
Practice Address - Street 1:3301 E 12TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3424
Practice Address - Country:US
Practice Address - Phone:510-533-6567
Practice Address - Fax:510-533-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11992 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119920Medicaid
CA154897Medicare PIN
CASD0119920Medicaid