MEDICARE: DR. AMBREEN ISMAIL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	35300TLG	CA
2	152W00000X	Optometrist	9313TG	TX

General Provider Information

NPI Number	:	1912402637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBREEN ISMAIL OD

Provider Business Mailing Address
First Line	:	5202 NATASHA RUN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3370
Country	:	US
Telephone Number	:	832-766-0876
Fax Number	:

Provider Business Practice Location Address
First Line	:	5202 NATASHA RUN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3370
Country	:	US
Telephone Number	:	832-766-0876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	04/28/2025

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