Provider Demographics
NPI:1669018198
Name:TALIANI, BASIM (OD)
Entity Type:Individual
Prefix:DR
First Name:BASIM
Middle Name:
Last Name:TALIANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16122 108 ST NW
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:AB
Mailing Address - Zip Code:T5X4Z7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4625 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6229
Practice Address - Country:US
Practice Address - Phone:602-760-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist