Healthcare Provider Details

I. General information

NPI: 1750503728
Provider Name (Legal Business Name): GHADA H ABDALLAH O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GHADA HASBANI O.D.

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 OLD AUSTIN HUTTO RD STE 100
PFLUGERVILLE TX
78660-4219
US

IV. Provider business mailing address

1010 OLD AUSTIN HUTTO RD STE 100
PFLUGERVILLE TX
78660-4219
US

V. Phone/Fax

Practice location:
  • Phone: 512-252-7075
  • Fax: 512-252-8825
Mailing address:
  • Phone: 512-252-7075
  • Fax: 512-252-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4843-T1708
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5405TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: