Basic Information
| Provider Information | |||||||||
| NPI: | 1598497067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABUSAAD | ||||||||
| FirstName: | HADI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 LUCAS DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752191804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145281354 | ||||||||
| FaxNumber: | 2145287387 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 LUCAS DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752191804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145281354 | ||||||||
| FaxNumber: | 2145287387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2022 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 10603 | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 10603 | 01 | TX | OPTOMETRY LICENSE | OTHER |