Provider Demographics
NPI:1194973065
Name:AZZAM, CLAIRE MICHELE (OD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:MICHELE
Last Name:AZZAM
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 1:828 E MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001
Mailing Address - Country:US
Mailing Address - Phone:805-643-5687
Mailing Address - Fax:805-643-4175
Practice Address - Street 1:828 E MAIN ST.
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:805-643-5687
Practice Address - Fax:805-643-4175
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007271-1152W00000X
CAOPT33453TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist