Healthcare Provider Details

I. General information

NPI: 1689693657
Provider Name (Legal Business Name): MAZIAR BIDAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E HERNDON AVENUE SUITE 301
FRESNO CA
93720-3326
US

IV. Provider business mailing address

1360 E HERNDON AVENUE SUITE 301
FRESNO CA
93720-3326
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-5000
  • Fax: 559-439-7854
Mailing address:
  • Phone: 559-486-5000
  • Fax: 559-439-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA86968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: