Provider Demographics
NPI:1134181159
Name:AZIZI, HABIB A (OD)
Entity type:Individual
Prefix:
First Name:HABIB
Middle Name:A
Last Name:AZIZI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2814 LEE BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1542
Mailing Address - Country:US
Mailing Address - Phone:239-303-2687
Mailing Address - Fax:239-303-2688
Practice Address - Street 1:2814 LEE BLVD
Practice Address - Street 2:STE 3
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1542
Practice Address - Country:US
Practice Address - Phone:239-303-2687
Practice Address - Fax:239-303-2688
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC3682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN2426OtherRAILROAD MEDICARE
FL958992OtherCIGNA
FL7693417OtherAETNA
FL19953OtherBLUE CROSS BLUE SHIELD
FL620756100Medicaid
FL1881883676OtherWEST FLORIDA EYE , INC.
FL19953OtherBLUE CROSS BLUE SHIELD
FL7693417OtherAETNA
FL958992OtherCIGNA