Provider Demographics
NPI:1366764862
Name:MODO OPTOMETRY
Entity type:Organization
Organization Name:MODO OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYYANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-305-2950
Mailing Address - Street 1:4718 ADMIRALTY WAY # B
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6905
Mailing Address - Country:US
Mailing Address - Phone:310-305-2950
Mailing Address - Fax:310-458-4799
Practice Address - Street 1:4718 ADMIRALTY WAY # B
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6905
Practice Address - Country:US
Practice Address - Phone:310-305-2950
Practice Address - Fax:310-458-4799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. S. DAYYANI, O.D., A PROFESSIONAL OPTOMETRIC CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10307T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty