Provider Demographics
NPI:1962595009
Name:AHMADI, LEILA (OD)
Entity type:Individual
Prefix:MS
First Name:LEILA
Middle Name:
Last Name:AHMADI
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 1:26800 CROWN VALLEY PARKWAY
Mailing Address - Street 2:SUITE #308
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8050
Mailing Address - Country:US
Mailing Address - Phone:949-489-2300
Mailing Address - Fax:949-489-2301
Practice Address - Street 1:26800 CROWN VALLEY PARKWAY
Practice Address - Street 2:SUITE #308
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8050
Practice Address - Country:US
Practice Address - Phone:949-489-2300
Practice Address - Fax:949-489-2301
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10838TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ5288Medicare PIN