Provider Demographics
NPI:1073792123
Name:AHMED, DEDRICK ABDUR-RAHMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DEDRICK
Middle Name:ABDUR-RAHMAN
Last Name:AHMED
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4948 GULFSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-7632
Mailing Address - Country:US
Mailing Address - Phone:972-387-3937
Mailing Address - Fax:972-387-0606
Practice Address - Street 1:13636 NEUTRON RD
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-4410
Practice Address - Country:US
Practice Address - Phone:972-368-3937
Practice Address - Fax:972-368-0606
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003471152W00000X
GAOPT003212152W00000X
TX05888TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist