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General NPI Number Information
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NPI Number | 1174762991
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Entity Type | Organization
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Legal Business Name | HUMERA SIDDIQUI, O.D., P.A.
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 904 CYPRESS PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34759-3456
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Country | US
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Telephone | 407-870-2405
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Fax | 407-870-2409
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Provider Business Mailing Address
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Address Line | 904 CYPRESS PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34759-3456
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Country | US
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Telephone | 407-870-2405
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Fax | 407-870-2409
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. HUMERA SIDDIQUI
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Credential | O.D.
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Telephone | 407-870-2405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3767
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License Number State | FL
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