Provider Demographics
NPI:1285686485
Name:HAKIMI, STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HAKIMI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 E SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE E
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3950
Mailing Address - Country:US
Mailing Address - Phone:713-473-5715
Mailing Address - Fax:713-473-3314
Practice Address - Street 1:4450 E SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE E
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3950
Practice Address - Country:US
Practice Address - Phone:713-473-5715
Practice Address - Fax:713-473-3314
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05804T6152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166841001Medicaid
TXV00137Medicare UPIN
TX610644Medicare ID - Type Unspecified