Provider Demographics
NPI:1316134653
Name:ALAVI, PONEH (OD)
Entity type:Individual
Prefix:DR
First Name:PONEH
Middle Name:
Last Name:ALAVI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25450 THE OLD RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1704
Mailing Address - Country:US
Mailing Address - Phone:661-253-3662
Mailing Address - Fax:661-253-4407
Practice Address - Street 1:25450 THE OLD RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1704
Practice Address - Country:US
Practice Address - Phone:661-253-3662
Practice Address - Fax:661-253-4407
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13233T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist