Kidisti Ghebre Mariam, OD
Optometrist in Antioch, CA. Individual provider (NPI-1).
NPI number1477508331
StatusActive
Last updated in NPPESJul 13, 2026
Details
- NPI
- 1477508331
- Entity type
- Individual (NPI-1)
- Name
- Kidisti Ghebre Mariam
- Credential
- OD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 22, 2006
- Last updated
- Jul 13, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 11703T | CA | Yes |
Practice location
2201 Verne Roberts CirAntioch, CA 94509-7911
Phone 925-757-1183
Mailing address
533 Ridgeview CtPleasant Hill, CA 94523-1023
Phone 925-228-2585
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All 35 Optometrist providers in Antioch · All 2,616 providers in Antioch
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