Provider Demographics
NPI:1235268061
Name:HAMIDEH, DINA (OD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:HAMIDEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E BELL RD STE 24
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2395
Mailing Address - Country:US
Mailing Address - Phone:602-375-1041
Mailing Address - Fax:
Practice Address - Street 1:401 E BELL RD STE 24
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-375-1041
Practice Address - Fax:602-375-7901
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3468152W00000X
AZ1717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162076Medicare PIN
AZZ163903Medicare PIN
AZZ163904Medicare PIN
AZZ162074Medicare PIN
AZZ163901Medicare PIN
AZZ162075Medicare PIN
AZZ162079Medicare PIN
AZZ162078Medicare PIN
AZ163902Medicare PIN
AZZ163900Medicare PIN
AZZ162077Medicare PIN
AZZ163905Medicare PIN