Provider Demographics
NPI:1316086960
Name:SUBHANI, NABIL (OD)
Entity type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:SUBHANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5860
Mailing Address - Country:US
Mailing Address - Phone:562-728-4324
Mailing Address - Fax:562-728-8864
Practice Address - Street 1:5290 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5860
Practice Address - Country:US
Practice Address - Phone:562-728-4324
Practice Address - Fax:562-728-8864
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10422T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0104221Medicaid
CAU56548Medicare UPIN
CASD0104220Medicare ID - Type Unspecified