Rezah Shoval Mohamed, D.O

Primary specialty

OptometristTaxonomy code 152W00000X

License

CA12960 Issued in CA

Practice address

17310 Bear Valley Road
Suite 101
Victorville, CA 92395

Phone

(760) 241-4499

Fax

(760) 243-9474

NPI assigned

Mar 28, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Rezah Shoval Mohamed Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paul J Dougherty M D Inc

  • Ophthalmology Physician
  • Westlake Village, CA
  • NPI 1649203639
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1104098292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1537 W 7TH STREET",
            "address_2": "APT 214",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "312-286-3193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17310 BEAR VALLEY ROAD",
            "address_2": "SUITE 101",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "92395",
            "telephone_number": "760-241-4499",
            "fax_number": "760-243-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "REZAH",
        "middle_name": "SHOVAL",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-28",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA12960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REZAH",
            "last_name": "MOHAMED",
            "middle_name": "SHOVAL",
            "prefix": "DR.",
            "credential": "D.O",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Mission City Community Network, Inc.
• Melvin Douglas Mitchell Jr., PMHNP
• Raynisha Lauraine Mitchell
• Erika Moberg
• Elijah Mobley, M.D.
• Mojave Chiropractic
• Mojave Dental Center
• Mojave Desert Hearing Aid Center
• Mojave Valley Physical Therapy
• Beverly Encarnacion Mojica, PHARMD.

• Optometrist in Victorville, CA
• Providers in Victorville, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.