Provider Demographics
NPI:1619154473
Name:SARA NIYATI-HADDADAN O.D.
Entity Type:Organization
Organization Name:SARA NIYATI-HADDADAN O.D.
Other - Org Name:ANGEL EYE CARE AND FAMILY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIYATI-HADDADAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-758-3937
Mailing Address - Street 1:1321 W. COVELL BLVD.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616
Mailing Address - Country:US
Mailing Address - Phone:530-758-3937
Mailing Address - Fax:530-758-3938
Practice Address - Street 1:1321 W. COVELL BLVD.
Practice Address - Street 2:SUITE 120
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-758-3937
Practice Address - Fax:530-758-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12977T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty