Provider Demographics
NPI:1972944189
Name:MERALI, MURTAZA (OD)
Entity type:Individual
Prefix:DR
First Name:MURTAZA
Middle Name:
Last Name:MERALI
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 1:3188 147 STREET
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V4P 3E7
Mailing Address - Country:CA
Mailing Address - Phone:604-790-5786
Mailing Address - Fax:
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:SUITE 1E-101
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-327-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA103106Medicare PIN
CACA103107Medicare PIN
CACA103105Medicare PIN