Healthcare Provider Details

I. General information

NPI: 1154683811
Provider Name (Legal Business Name): OMAR MUHAMMAD SHOUKFEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 50TH ST
LUBBOCK TX
79413-3911
US

IV. Provider business mailing address

5109 80TH ST
LUBBOCK TX
79424
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-5900
  • Fax: 806-792-6092
Mailing address:
  • Phone: 806-792-5900
  • Fax: 806-792-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberQ8640
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberQ8640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: