Healthcare Provider Details

I. General information

NPI: 1376796821
Provider Name (Legal Business Name): HARRIS AHMAD ABBASI OD, MHA, FAAO, LSSBB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 06/24/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONCRIEF ARMY HEALTH CLINIC 4500 8TH INF DIV STREET
FT JACKSON SC
29207
US

IV. Provider business mailing address

1585 3RD ST
FORT POLK LA
71459-5102
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-7484
  • Fax:
Mailing address:
  • Phone: 337-531-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002379
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: