Provider Demographics
NPI:1891360111
Name:ZADRAN, FAWAD (OD)
Entity Type:Individual
Prefix:
First Name:FAWAD
Middle Name:
Last Name:ZADRAN
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 1:1089 CRESTLINE CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7224
Mailing Address - Country:US
Mailing Address - Phone:916-850-9829
Mailing Address - Fax:
Practice Address - Street 1:1113 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249
Practice Address - Country:US
Practice Address - Phone:209-755-1480
Practice Address - Fax:209-674-6190
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34832152W00000X
COOPT.0003687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist