Provider Demographics
NPI:1851085120
Name:NIKTABE, ASHKAN (OD)
Entity type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:
Last Name:NIKTABE
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14159 DICKENS ST APT 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:818-703-9079
Practice Address - Street 1:6433 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3543
Practice Address - Country:US
Practice Address - Phone:818-703-1410
Practice Address - Fax:818-703-9079
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist