Provider Demographics
NPI:1457623266
Name:AMED, ZIBA (OD)
Entity Type:Individual
Prefix:
First Name:ZIBA
Middle Name:
Last Name:AMED
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 1:34420 FREMONT BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3323
Mailing Address - Country:US
Mailing Address - Phone:510-796-9600
Mailing Address - Fax:510-796-9691
Practice Address - Street 1:34420 FREMONT BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3323
Practice Address - Country:US
Practice Address - Phone:510-796-9600
Practice Address - Fax:510-796-9691
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14254T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA981ZMedicaid