Provider Demographics
NPI:1609926781
Name:SAREMI, SHAHRIYAR S (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAHRIYAR
Middle Name:S
Last Name:SAREMI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 W. PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2352
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:91331-2352
Practice Address - Country:US
Practice Address - Phone:818-890-9600
Practice Address - Fax:818-890-9697
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1271TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0121710Medicaid