Healthcare Provider Details

I. General information

NPI: 1356814081
Provider Name (Legal Business Name): EZAH CHEEMA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 PINOLE VALLEY RD
PINOLE CA
94564-1425
US

IV. Provider business mailing address

3405 W CENTRAL AVE
TOLEDO OH
43606-1402
US

V. Phone/Fax

Practice location:
  • Phone: 510-222-6567
  • Fax: 510-222-2161
Mailing address:
  • Phone: 419-381-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006699
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9598
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: