Provider Demographics
NPI:1891471603
Name:GHEBLAWI, ZENAH (OD)
Entity Type:Individual
Prefix:
First Name:ZENAH
Middle Name:
Last Name:GHEBLAWI
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 1:3613 BONITA RANCH CT
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2714
Mailing Address - Country:US
Mailing Address - Phone:714-393-5343
Mailing Address - Fax:
Practice Address - Street 1:19075 I 45 S STE 121B
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8772
Practice Address - Country:US
Practice Address - Phone:936-271-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10824T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist