Provider Demographics
NPI:1962644526
Name:ALI, ANNISHA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNISHA
Middle Name:
Last Name:ALI
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 1:8651 NW 13TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1512
Mailing Address - Country:US
Mailing Address - Phone:305-594-9336
Mailing Address - Fax:305-470-4563
Practice Address - Street 1:8651 NW 13TH TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1512
Practice Address - Country:US
Practice Address - Phone:305-594-9336
Practice Address - Fax:305-470-4563
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007319152W00000X
FLOPC4289152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist