Provider Demographics
NPI:1730252867
Name:TALEBI, MAHMOOD (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:TALEBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EYE CARE FIRST
Other - Middle Name:
Other - Last Name:EYE CARE FIRST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23166 LOS ALISOS BLVD
Mailing Address - Street 2:SUITE 112B
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2835
Mailing Address - Country:US
Mailing Address - Phone:949-707-1181
Mailing Address - Fax:949-707-1192
Practice Address - Street 1:23166 LOS ALISOS BLVD
Practice Address - Street 2:SUITE 112B
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2835
Practice Address - Country:US
Practice Address - Phone:949-707-1181
Practice Address - Fax:949-707-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052012207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A521020Medicaid
CA00A520121Medicaid
CA00A521020Medicaid
CA00A520121Medicaid
CAE03997Medicare UPIN