Healthcare Provider Details

I. General information

NPI: 1336704410
Provider Name (Legal Business Name): ELHAM GHAHARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N ALVERNON WAY STE 301
TUCSON AZ
85711-1848
US

IV. Provider business mailing address

655 N ALVERNON WAY STE 204
TUCSON AZ
85711-1825
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-1460
  • Fax:
Mailing address:
  • Phone: 312-843-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number55612
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number297355
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number73176
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: