Provider Demographics
NPI:1760491948
Name:RABBANI, RAMIN ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:ANTHONY
Last Name:RABBANI
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 1:12240 1/2 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2518
Mailing Address - Country:US
Mailing Address - Phone:818-985-3937
Mailing Address - Fax:
Practice Address - Street 1:12240 1/2 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2518
Practice Address - Country:US
Practice Address - Phone:818-985-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11736T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWY4421QOtherGROUP #
CAU89006Medicare UPIN
CAWOP11736AMedicare ID - Type UnspecifiedPPIN #