Provider Demographics
NPI:1306916978
Name:PEDARSANI, NASIM (OD)
Entity type:Individual
Prefix:DR
First Name:NASIM
Middle Name:
Last Name:PEDARSANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18649 VIA PRINCESSA
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-4935
Mailing Address - Country:US
Mailing Address - Phone:773-459-6192
Mailing Address - Fax:
Practice Address - Street 1:18649 VIA PRINCESSA
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-4935
Practice Address - Country:US
Practice Address - Phone:773-459-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13424T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist