Provider Demographics
NPI:1699298166
Name:NIKA OMID, MD INC
Entity type:Organization
Organization Name:NIKA OMID, MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-663-9888
Mailing Address - Street 1:4950 BARRANCA PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4950 BARRANCA PKWY STE 111
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4630
Practice Address - Country:US
Practice Address - Phone:949-652-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty