Provider Demographics
NPI:1184429029
Name:KHALIL, FADI
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:KHALIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3958 CASTRO VALLEY BLVD APT 34
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6029
Mailing Address - Country:US
Mailing Address - Phone:510-517-5235
Mailing Address - Fax:
Practice Address - Street 1:3958 CASTRO VALLEY BLVD APT 34
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6029
Practice Address - Country:US
Practice Address - Phone:510-517-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist