Healthcare Provider Details

I. General information

NPI: 1679873251
Provider Name (Legal Business Name): DR ALI MOHEBBI OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BRISTOL ST
COSTA MESA CA
92626-1873
US

IV. Provider business mailing address

PO BOX 3326
MISSION VIEJO CA
92690-1326
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-7800
  • Fax: 714-557-8006
Mailing address:
  • Phone: 714-557-7800
  • Fax: 714-557-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11257T
License Number StateCA

VIII. Authorized Official

Name: DR. ALI A MOHEBBI
Title or Position: PRESIDENT/OWNER
Credential: OD
Phone: 714-557-7800