Provider Demographics
NPI:1174665301
Name:KABIR, FAHIM M (O D)
Entity type:Individual
Prefix:DR
First Name:FAHIM
Middle Name:M
Last Name:KABIR
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E MONTE VISTA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3106
Mailing Address - Country:US
Mailing Address - Phone:916-903-6876
Mailing Address - Fax:
Practice Address - Street 1:2545 E BIDWELL ST
Practice Address - Street 2:SUITE 160
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6440
Practice Address - Country:US
Practice Address - Phone:916-983-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13111T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist