Provider Demographics
NPI:1235164377
Name:IDRIS, SAMIA (OD)
Entity Type:Individual
Prefix:
First Name:SAMIA
Middle Name:
Last Name:IDRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:2100 PLEASANT HILL RD
Practice Address - Street 2:H10-1
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4701
Practice Address - Country:US
Practice Address - Phone:678-475-0500
Practice Address - Fax:678-475-0563
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT001870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist