Provider Demographics
NPI:1427005099
Name:AHAD MAHOOTCHI, MD, PA
Entity Type:Organization
Organization Name:AHAD MAHOOTCHI, MD, PA
Other - Org Name:THE EYE CLINIC OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHOOTCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-779-3338
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-1059
Mailing Address - Country:US
Mailing Address - Phone:813-779-3338
Mailing Address - Fax:813-779-3318
Practice Address - Street 1:6739 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2522
Practice Address - Country:US
Practice Address - Phone:813-779-3338
Practice Address - Fax:813-779-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X, 207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE5595OtherRAILROAD MEDICARE
FL97315OtherBCBS FLORIDA GROUP NUMBER
FL97315OtherBCBS FLORIDA GROUP NUMBER
FL4402200001Medicare NSC