Provider Demographics
NPI:1538984083
Name:HABIBI, BRESHNA (OD)
Entity type:Individual
Prefix:
First Name:BRESHNA
Middle Name:
Last Name:HABIBI
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 1:6038 LEDGEFERN CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-9187
Mailing Address - Country:US
Mailing Address - Phone:925-502-7164
Mailing Address - Fax:
Practice Address - Street 1:175 MARKET PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4741
Practice Address - Country:US
Practice Address - Phone:925-275-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist