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General NPI Number Information
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NPI Number | 1811039266
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Entity Type | Individual
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Provider Name | KHALED OTHMAN ABUMAYALEH OD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1030 HUNTERS CROSSING LANE
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City | ALCOA
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State | TN
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Zip | 37701
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Country | US
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Telephone | 865-984-1100
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Fax | 865-984-8305
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Provider Business Mailing Address
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Address Line | 761 FOX LANDING LANE
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City | KNOXVILLE
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State | TN
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Zip | 37922
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Country | US
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Telephone | 865-671-6127
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1848
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1827
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License Number State | GA
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