Healthcare Provider Details

I. General information

NPI: 1205023801
Provider Name (Legal Business Name): AMRO HABIB OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 N CORTARO RD
TUCSON AZ
85743-9393
US

IV. Provider business mailing address

7400 N CLEMENS WAY
TUCSON AZ
85743-8261
US

V. Phone/Fax

Practice location:
  • Phone: 520-744-6721
  • Fax: 520-744-6724
Mailing address:
  • Phone: 520-744-6721
  • Fax: 520-744-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number01129
License Number StateAZ

VIII. Authorized Official

Name: DR. AMRO NASHAT HABIB
Title or Position: MEMBER
Credential: OD
Phone: 520-661-4555