MEDICARE: DR. MASHIA GHODS O.D.

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	14644	CA

General Provider Information

NPI Number	:	1558703868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASHIA GHODS O.D.

Provider Business Mailing Address
First Line	:	11440 WESTONHILL DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-1451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 CAMINO DEL RIO N
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1506
Country	:	US
Telephone Number	:	858-231-2238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2013
Last Update Date	:	10/24/2024

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