Provider Demographics
NPI:1790118297
Name:SALEKI, SEPIDEH (OD)
Entity Type:Individual
Prefix:DR
First Name:SEPIDEH
Middle Name:
Last Name:SALEKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 S ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2085
Mailing Address - Country:US
Mailing Address - Phone:480-615-9852
Mailing Address - Fax:480-833-9198
Practice Address - Street 1:1365 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2085
Practice Address - Country:US
Practice Address - Phone:480-615-9852
Practice Address - Fax:480-833-9198
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3319-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist