| Doctor Name: | DR. SANAZ STACY ABOUTALEBI-SIMON |
| NPI Number: | 1033319215 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | O.D. |
| License Number: | 12259T |
| Business Practice Address: | 3400 Delta Fair Blvd The Permanente Medical Group, Inc. Antioch, CA - 945094004 |
| Business Phone Number: | 9257795223 |
| Business Fax Number: | 9257795421 |
| Mailing Address: | 2640 Buena Vista Ave, WALNUT CREEK |
| State: | CA |
| Postal Code: | 945972502 |
| Phone Number: | 9257269711 |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2007 |
| NPI Last Update Date: | 10/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 12259T |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |