Healthcare Provider Details

I. General information

NPI: 1891627717
Provider Name (Legal Business Name): MAHA HABIB AHMED OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SYLVAN AVE STE B
MODESTO CA
95350-1699
US

IV. Provider business mailing address

4846 PORTER ST
FREMONT CA
94538-2526
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-2020
  • Fax:
Mailing address:
  • Phone: 510-358-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: