Provider Demographics
NPI:1962677369
Name:NAZARI, LADAN (OD)
Entity Type:Individual
Prefix:DR
First Name:LADAN
Middle Name:
Last Name:NAZARI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LADAN
Other - Middle Name:
Other - Last Name:NAZARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1054 SANTA ROSA PLZ
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6345
Mailing Address - Country:US
Mailing Address - Phone:707-544-3000
Mailing Address - Fax:
Practice Address - Street 1:1054 SANTA ROSA PLZ
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6345
Practice Address - Country:US
Practice Address - Phone:707-544-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9883T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist