Provider Demographics
NPI:1780700989
Name:SHIRAZIAN, FOAD JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:FOAD
Middle Name:JOSEPH
Last Name:SHIRAZIAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18399 VENTURA BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6416
Mailing Address - Country:US
Mailing Address - Phone:818-757-3200
Mailing Address - Fax:818-757-0318
Practice Address - Street 1:18399 VENTURA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6416
Practice Address - Country:US
Practice Address - Phone:818-757-3090
Practice Address - Fax:818-757-0318
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11746T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABQ107AMedicaid