Provider Demographics
NPI:1679873251
Name:DR ALI MOHEBBI OD INC
Entity Type:Organization
Organization Name:DR ALI MOHEBBI OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHEBBI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-557-7800
Mailing Address - Street 1:PO BOX 3326
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-1326
Mailing Address - Country:US
Mailing Address - Phone:714-557-7800
Mailing Address - Fax:714-557-8006
Practice Address - Street 1:3333 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1873
Practice Address - Country:US
Practice Address - Phone:714-557-7800
Practice Address - Fax:714-557-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11257T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0112570Medicaid