Basic Information
| Provider Information | |||||||||
| NPI: | 1194893008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAYYANI | ||||||||
| FirstName: | SHAHROKH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 496084 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960496084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302410473 | ||||||||
| FaxNumber: | 5302415377 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103196122 | ||||||||
| FaxNumber: | 3104584799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | T10307 | CA | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WL0500X | T10307 | CA | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152WP0200X | T10307 | CA | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | T10307 | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | GSD001450 | 05 | CA | MEDICAID |