Provider Demographics
NPI:1740694868
Name:SHAKIL-ANSARI, SANA (OD)
Entity type:Individual
Prefix:
First Name:SANA
Middle Name:
Last Name:SHAKIL-ANSARI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SANA
Other - Middle Name:
Other - Last Name:SHAKIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
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 STE 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:951-498-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14762TLG152W00000X
NJ27OA00652700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist