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General NPI Number Information
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NPI Number | 1598024622
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Entity Type | Organization
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Legal Business Name | LEILA AHMADI OD, APC, AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 26800 CROWN VALLEY PKWY SUITE #308
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6384
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Country | US
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Telephone | 949-489-2300
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Fax | 949-489-2301
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Provider Business Mailing Address
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Address Line | 26800 CROWN VALLEY PKWY SUITE #308
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6384
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Country | US
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Telephone | 949-489-2300
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Fax | 949-489-2301
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEILA AHMADI
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Credential | O.D.
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Telephone | 949-489-2300
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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 | 10838TPG
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License Number State | CA
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