Provider Demographics
NPI:1689344517
Name:EL-GHALI, AHMAD SAADEDDINE (OD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:SAADEDDINE
Last Name:EL-GHALI
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 1:21025 LULL ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5613
Mailing Address - Country:US
Mailing Address - Phone:818-854-5369
Mailing Address - Fax:
Practice Address - Street 1:2001 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1813
Practice Address - Country:US
Practice Address - Phone:805-983-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34961-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist