Provider Demographics
NPI:1710489927
Name:DR. PARIYA SHAMSAEE, O.D., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. PARIYA SHAMSAEE, O.D., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSAEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-482-7130
Mailing Address - Street 1:PO BOX 500481
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-0481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 EASTLAKE PKWY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3558
Practice Address - Country:US
Practice Address - Phone:619-482-7130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty