Provider Demographics
NPI:1134314222
Name:ALAM, SHANZIDA HUSAIN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANZIDA
Middle Name:HUSAIN
Last Name:ALAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 TAYLORWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5130
Mailing Address - Country:US
Mailing Address - Phone:281-610-2058
Mailing Address - Fax:
Practice Address - Street 1:24201 BRAZOS TOWN CROSSING
Practice Address - Street 2:JC PENNY
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471
Practice Address - Country:US
Practice Address - Phone:281-610-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7029T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist