Healthcare Provider Details

I. General information

NPI: 1932034048
Provider Name (Legal Business Name): MOHAMMED ISLAM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5057 N DIXIE HWY
OAKLAND PARK FL
33334-4003
US

IV. Provider business mailing address

7120 SW 9TH ST
PEMBROKE PINES FL
33023-1641
US

V. Phone/Fax

Practice location:
  • Phone: 954-756-5248
  • Fax:
Mailing address:
  • Phone: 954-756-5248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: