Healthcare Provider Details

I. General information

NPI: 1649947805
Provider Name (Legal Business Name): DR. ALAA ALSURADI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 UNIVERSITY BLVD
GALVESTON TX
77550-5552
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-5823
  • Fax: 409-747-5825
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number86673
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number47984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: