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General NPI Number Information
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NPI Number | 1164839601
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Entity Type | Individual
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Provider Name | IHAB MASSAD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 5597 SEMINARY RD APT 2417S
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City | FALLS CHURCH
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State | VA
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Zip | 22041-2923
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Country | US
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Telephone | 202-415-5891
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Fax |
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Provider Business Mailing Address
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Address Line | 5597 SEMINARY RD APT 2417S
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City | FALLS CHURCH
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State | VA
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Zip | 22041-2923
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Country | US
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Telephone | 202-415-5891
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 0116026982
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | P29964
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | MTL002518
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License Number State | DC
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