Provider Demographics
NPI:1225531676
Name:QATTAN, IBRAHIM (OD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:QATTAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3111 UNICORN LAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0118
Mailing Address - Country:US
Mailing Address - Phone:940-891-3937
Mailing Address - Fax:940-591-8368
Practice Address - Street 1:3111 UNICORN LAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0118
Practice Address - Country:US
Practice Address - Phone:940-891-3937
Practice Address - Fax:940-591-8368
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9326T152WC0802X, 152WX0102X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics