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General NPI Number Information
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NPI Number | 1326019027
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Entity Type | Organization
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Legal Business Name | AMAAL ODISH OD INC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 844 E WASHINGTON AVE
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City | EL CAJON
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State | CA
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Zip | 92020
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Country | US
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Telephone | 619-447-1139
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Fax | 619-447-6239
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Provider Business Mailing Address
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Address Line | 844 EAST WASHINGTON AVE
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City | EL CAJON
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State | CA
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Zip | 92020
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Country | US
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Telephone | 619-447-1139
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Fax | 619-447-6239
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Authorized Official
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Title or Position | CEO DOCTOR OF OPTOMETRY
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Name | MRS. AMAAL ODISH
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Credential | OD
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Telephone | 619-447-1139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11379TPA
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License Number State | CA
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