MEDICARE: ALY-HUSSAIN JIWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5919	FL

General Provider Information

NPI Number	:	1235707167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALY-HUSSAIN JIWA

Provider Business Mailing Address
First Line	:	1325 BAY HARBOR DR APT 104
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3410
Country	:	US
Telephone Number	:	781-535-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	13620 UNIVERSITY PLAZA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4649
Country	:	US
Telephone Number	:	813-462-4985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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Directions to “ ALY-HUSSAIN JIWA ” Practice Location

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