Provider Demographics
NPI:1609534379
Name:ALI OPTOMETRY PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ALI OPTOMETRY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-771-0666
Mailing Address - Street 1:3245 SPORTS ARENA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4529
Mailing Address - Country:US
Mailing Address - Phone:707-771-0666
Mailing Address - Fax:
Practice Address - Street 1:3245 SPORTS ARENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4529
Practice Address - Country:US
Practice Address - Phone:707-771-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty