MEDICARE: JAWAD NAZIR AHMAD MD

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	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	A177942	CA
2	207WX0120X	Cornea and External Diseases Specialist Physician	177942	CA
3	207W00000X	Ophthalmology Physician	A177942	CA

General Provider Information

NPI Number	:	1841797248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWAD NAZIR AHMAD MD

Provider Business Mailing Address
First Line	:	3855 BROAD ST STE B
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7109
Country	:	US
Telephone Number	:	805-545-7881
Fax Number	:	805-548-8785

Provider Business Practice Location Address
First Line	:	3855 BROAD ST STE B
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7109
Country	:	US
Telephone Number	:	805-545-8100
Fax Number	:	805-548-8785

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

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	09/20/2023

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