Provider Demographics
NPI:1851393086
Name:AMIR, AHMAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:A
Last Name:AMIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3855 BROAD STREET
Mailing Address - Street 2:STE B
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-545-7881
Mailing Address - Fax:805-548-8785
Practice Address - Street 1:816 E ENOS DR
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7295
Practice Address - Country:US
Practice Address - Phone:805-346-1717
Practice Address - Fax:805-346-1525
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG84926207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20155344 93401 A001OtherTRICARE GRP PIN - SLO
CAZZZ65444ZOtherBLUE SHIELD TMPLTN GP PIN
CAGR0099341Medicaid
CAZZZ09808ZOtherBLUE SHIELD SLO GRP PIN
CAZZZ09809ZOtherBLUE SHIELD AG GRP PIN
CA201555344 93420 A001OtherTRICARE GRP PIN - AG
CAG84926OtherMEDICAL LICENSE NUMBER
CAGR0099340Medicaid
CAGR0099343Medicaid
P00213688OtherINDIV RR MEDICARE PIN
CAZZZ09810ZOtherBLUE SHIELD SM GRP PIN
CA1117OtherCMSP GRP PIN
CA201555344 93454 A001OtherTRICARE GROUP PIN - SM
CAGR0099342Medicaid
CA00G849260Medicaid
DC7249OtherRR MEDICARE GRP PIN
CA1117OtherCMSP GRP PIN
CAG84926OtherMEDICAL LICENSE NUMBER
CAGR0099341Medicaid
CA00G849260Medicaid