Healthcare Provider Details

I. General information

NPI: 1851962617
Provider Name (Legal Business Name): AZKA AHMED OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AZKA ABDULMUJIB OD

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N 5TH ST
SILSBEE TX
77656-4030
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-5262
  • Fax: 409-385-6497
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: