Provider Demographics
NPI:1184764011
Name:TAVASSOLI, SARA FARNAZ (OD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:FARNAZ
Last Name:TAVASSOLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:FARNAZ
Other - Middle Name:
Other - Last Name:TAVASSOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:24662 EL MANZANO
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7637
Mailing Address - Country:US
Mailing Address - Phone:301-538-0032
Mailing Address - Fax:240-328-6311
Practice Address - Street 1:288 N SANTA ANITA AVE STE 103
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3183
Practice Address - Country:US
Practice Address - Phone:626-829-8185
Practice Address - Fax:626-829-8186
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1989152W00000X
CAOPT13395TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist