MEDICARE: DR. HASEEB AYUBE BACCHUS OD

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	9861TG	TX

General Provider Information

NPI Number	:	1700436417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HASEEB AYUBE BACCHUS OD

Provider Business Mailing Address
First Line	:	2454 CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3720
Country	:	US
Telephone Number	:	281-537-2020
Fax Number	:	281-537-2020

Provider Business Practice Location Address
First Line	:	2454C CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3720
Country	:	US
Telephone Number	:	281-537-2020
Fax Number	:

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

Provider Enumeration Date	:	09/14/2019
Last Update Date	:	12/02/2025

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