Healthcare Provider Details

I. General information

NPI: 1346121597
Provider Name (Legal Business Name): DR. MOHAMED ABOBAKR ALY MOHAMED NASSR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 440-735-3801
  • Fax: 440-735-4255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberAPP-000986231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: