=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700436417
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HASEEB AYUBE BACCHUS OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2019
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2454C CYPRESS CREEK PKWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77068-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-537-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2454 CYPRESS CREEK PKWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77068-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-537-2020
-----------------------------------------------------
Fax | 281-537-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 9861TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------