Provider Demographics
NPI:1720787070
Name:SANA SHAKIL-ANSARI O.D. INC
Entity Type:Organization
Organization Name:SANA SHAKIL-ANSARI O.D. INC
Other - Org Name:VISIONAIRE OPTOMETRY SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKIL-ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-913-0005
Mailing Address - Street 1:18876 VAN BUREN BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9114
Mailing Address - Country:US
Mailing Address - Phone:951-498-3937
Mailing Address - Fax:
Practice Address - Street 1:18876 VAN BUREN BLVD # 204
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9114
Practice Address - Country:US
Practice Address - Phone:909-913-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740694868OtherNPI