Provider Demographics
NPI:1275971145
Name:ABILMOUNA, RAYAN (OD)
Entity Type:Individual
Prefix:
First Name:RAYAN
Middle Name:
Last Name:ABILMOUNA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:ABILMOUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4899 GRIGGS RD
Mailing Address - Street 2:A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021
Mailing Address - Country:US
Mailing Address - Phone:713-748-5000
Mailing Address - Fax:713-748-8707
Practice Address - Street 1:4899 GRIGGS RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2855
Practice Address - Country:US
Practice Address - Phone:713-748-5000
Practice Address - Fax:713-748-8707
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8189TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343216303Medicaid