Basic Information
| Provider Information | |||||||||
| NPI: | 1205023801 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMRO HABIB OD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7400 N CLEMENS WAY | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857438261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207446721 | ||||||||
| FaxNumber: | 5207446724 | ||||||||
| Practice Location | |||||||||
| Address1: | 8280 N CORTARO RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857439393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207446721 | ||||||||
| FaxNumber: | 5207446724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 09/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | HABIB | ||||||||
| AuthorizedOfficialFirstName: | AMRO | ||||||||
| AuthorizedOfficialMiddleName: | NASHAT | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5206614555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS0132X | 01129 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Ophthalmologic Surgery |
No ID Information.