Provider Demographics
NPI:1194893008
Name:DAYYANI, SHAHROKH (OD)
Entity type:Individual
Prefix:DR
First Name:SHAHROKH
Middle Name:
Last Name:DAYYANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2401
Mailing Address - Country:US
Mailing Address - Phone:310-319-6122
Mailing Address - Fax:213-378-2716
Practice Address - Street 1:2635 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2401
Practice Address - Country:US
Practice Address - Phone:310-319-6122
Practice Address - Fax:310-458-4799
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT10307152WC0802X, 152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD001450Medicaid
CAOP10307Medicare ID - Type Unspecified
CAU51954Medicare UPIN