Healthcare Provider Details

I. General information

NPI: 1578129078
Provider Name (Legal Business Name): HYDER JAMAL ALMOSAWY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NORTHEAST RD
STANDISH ME
04084-6427
US

IV. Provider business mailing address

40 NORTHEAST RD
STANDISH ME
04084-6427
US

V. Phone/Fax

Practice location:
  • Phone: 207-389-3525
  • Fax:
Mailing address:
  • Phone: 207-389-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG0676
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5346
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: