Provider Demographics
NPI:1972572980
Name:KAZEMI, ISABEL (OD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:KAZEMI
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 1:5515 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121
Mailing Address - Country:US
Mailing Address - Phone:415-387-3553
Mailing Address - Fax:415-387-3942
Practice Address - Street 1:5515 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121
Practice Address - Country:US
Practice Address - Phone:415-387-3553
Practice Address - Fax:415-387-3942
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10343T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51833Medicare UPIN
CA6049990001Medicare NSC
CASD0103430Medicare ID - Type Unspecified