Provider Demographics
NPI:1285876524
Name:ESFANDIARI, RAMBOD (OD)
Entity type:Individual
Prefix:DR
First Name:RAMBOD
Middle Name:
Last Name:ESFANDIARI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:RAMBOD
Other - Middle Name:
Other - Last Name:ESFANDIARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR OF OPTOMETRY
Mailing Address - Street 1:3895 CLAIREMONT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5833
Mailing Address - Country:US
Mailing Address - Phone:858-272-0020
Mailing Address - Fax:858-272-0026
Practice Address - Street 1:3895 CLAIREMONT DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5833
Practice Address - Country:US
Practice Address - Phone:858-272-0020
Practice Address - Fax:858-272-0026
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist