Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | S446TA263 | AL |
NPI | 1013005354 |
---|---|
Provider Name | Dr. Mazen Naji Sahawneh |
First Address | Mobile, AL 36604-2407 |
Second Address | Mobile, AL 36608-3792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T69051 | (02) | AL |