Provider Demographics
NPI:1043087117
Name:FARAG, SAMEH SAMIR (OD7295)
Entity Type:Individual
Prefix:MR
First Name:SAMEH
Middle Name:SAMIR
Last Name:FARAG
Suffix:
Gender:M
Credentials:OD7295
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12741 BOGGY POINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824
Mailing Address - Country:US
Mailing Address - Phone:407-438-0274
Mailing Address - Fax:407-438-0274
Practice Address - Street 1:9498 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8322
Practice Address - Country:US
Practice Address - Phone:407-351-1433
Practice Address - Fax:407-351-1433
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7295156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician