Provider Demographics
NPI:1902052855
Name:MAKOSHI, GHADEER A (OD,FAAO)
Entity Type:Individual
Prefix:
First Name:GHADEER
Middle Name:A
Last Name:MAKOSHI
Suffix:
Gender:F
Credentials:OD,FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:
Practice Address - Street 1:220 N MCKEMY AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2654
Practice Address - Country:US
Practice Address - Phone:480-961-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1681152WP0200X
MO2008023450152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144717OtherMEDICARE PTAN
AZZ165088Medicare PIN
AZZ165055Medicare PIN
AZZ164043Medicare PIN
AZZ162076Medicare PIN
AZZ162078Medicare PIN
AZZ165054Medicare PIN
AZZ165052Medicare PIN
AZZ162077Medicare PIN
AZZ144717OtherMEDICARE PTAN
AZZ162074Medicare PIN
AZZ162079Medicare PIN
AZZ165056Medicare PIN