MEDICARE: MARVIN C MAH, OD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	CA6996T	CA

General Provider Information

NPI Number	:	1437417433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVIN C MAH, OD, INC

Provider Business Mailing Address
First Line	:	1556 WASHINGTON BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94539-5100
Country	:	US
Telephone Number	:	510-438-0508
Fax Number	:	510-661-2362

Provider Business Practice Location Address
First Line	:	1556 WASHINGTON BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94539-5100
Country	:	US
Telephone Number	:	510-438-0508
Fax Number	:	510-661-2362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARVIN C MAH
Credential	:	O.D.
Telephone Number	:	510-438-0508

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/26/2012

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