Healthcare Provider Details

I. General information

NPI: 1134757479
Provider Name (Legal Business Name): ABDULLAH ABOU-SAMRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20525 AMBERFIELD DR UNIT 101
LAND O LAKES FL
34638-4381
US

IV. Provider business mailing address

20525 AMBERFIELD DR UNIT 101
LAND O LAKES FL
34638-4381
US

V. Phone/Fax

Practice location:
  • Phone: 813-921-8815
  • Fax: 813-463-0167
Mailing address:
  • Phone: 813-921-8815
  • Fax: 813-463-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0099545
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD500002845
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101281391
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME176964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: