Provider Demographics
NPI:1740017185
Name:EYEDOCTOR OPTOMETRY LAGUNA WOODS INC
Entity type:Organization
Organization Name:EYEDOCTOR OPTOMETRY LAGUNA WOODS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHKAN
Authorized Official - Middle Name:TAVAKOLI
Authorized Official - Last Name:ISFAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-658-1870
Mailing Address - Street 1:24301 PASEO DE VALENCIA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3111
Mailing Address - Country:US
Mailing Address - Phone:256-658-1870
Mailing Address - Fax:
Practice Address - Street 1:24301 PASEO DE VALENCIA
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3111
Practice Address - Country:US
Practice Address - Phone:256-658-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty