Healthcare Provider Details

I. General information

NPI: 1750189239
Provider Name (Legal Business Name): MARIAM IBRAHIM LABIB OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13904 N DALE MABRY HWY
TAMPA FL
33618-2446
US

IV. Provider business mailing address

35 CAROLWOOD CRES
MARKHAM ONTARIO
L3S4T2
CA

V. Phone/Fax

Practice location:
  • Phone: 813-908-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberXXXXXXXX
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: