Provider Demographics
NPI:1972263457
Name:MAGHAMI, NIMA (OD)
Entity Type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:MAGHAMI
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 1:12330 VANCE JACKSON RD APT 14307
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-6038
Mailing Address - Country:US
Mailing Address - Phone:210-862-7853
Mailing Address - Fax:
Practice Address - Street 1:7400 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5399
Practice Address - Country:US
Practice Address - Phone:210-342-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist