Provider Demographics
NPI: | 1902212194 |
---|---|
Name: | MASOUD NAFEY OD INC |
Entity Type: | Organization |
Organization Name: | MASOUD NAFEY OD INC |
Other - Org Name: | VISION UNION FAMILY OPTOMETRY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO/PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MASOUD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NAFEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 925-922-9705 |
Mailing Address - Street 1: | 1930 9TH ST |
Mailing Address - Street 2: | SUITE 206 |
Mailing Address - City: | SACRAMENTO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95811-7043 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1930 9TH ST |
Practice Address - Street 2: | SUITE 206 |
Practice Address - City: | SACRAMENTO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95811-7043 |
Practice Address - Country: | US |
Practice Address - Phone: | 925-922-9705 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-07-08 |
Last Update Date: | 2014-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 14613TLG | 305R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 305R00000X | Managed Care Organizations | Preferred Provider Organization |