Healthcare Provider Details

I. General information

NPI: 1235598087
Provider Name (Legal Business Name): YOUSEF ALDAIRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W MARKET ST
LIMA OH
45805-2795
US

IV. Provider business mailing address

2010 BREMO RD STE 128A
RICHMOND VA
23226-2444
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-6181
  • Fax:
Mailing address:
  • Phone: 877-969-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberLT000755
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number270680
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2018-00840
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.146052
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: