Provider Demographics
NPI:1548924202
Name:HAMOUDA, TAISIR MOHAMED (DO)
Entity type:Individual
Prefix:
First Name:TAISIR
Middle Name:MOHAMED
Last Name:HAMOUDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4910
Mailing Address - Country:US
Mailing Address - Phone:347-606-2020
Mailing Address - Fax:
Practice Address - Street 1:244 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4910
Practice Address - Country:US
Practice Address - Phone:347-606-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist