Provider Demographics
NPI:1710597240
Name:ALKAWALLY, MARIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:ALKAWALLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 GASOL CT APT V203
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-6178
Mailing Address - Country:US
Mailing Address - Phone:657-243-5674
Mailing Address - Fax:
Practice Address - Street 1:4105 EMPIRE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0637
Practice Address - Country:US
Practice Address - Phone:661-843-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34605152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management