Provider Demographics
NPI:1477114296
Name:MOINUDDIN, OMAR MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:MOHAMMED
Last Name:MOINUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MORRISON PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1352
Mailing Address - Country:US
Mailing Address - Phone:817-865-6800
Mailing Address - Fax:817-865-6790
Practice Address - Street 1:305 MORRISON PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1352
Practice Address - Country:US
Practice Address - Phone:817-865-6800
Practice Address - Fax:817-865-6790
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351044807207W00000X
TXV8695207W00000X
MI4301509019207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology