Healthcare Provider Details

I. General information

NPI: 1578486379
Provider Name (Legal Business Name): MARYAM ABBAS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W MCDOWELL RD
AVONDALE AZ
85392-4803
US

IV. Provider business mailing address

10000 W MCDOWELL RD
AVONDALE AZ
85392-4803
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-5661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002976
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: