Provider Demographics
NPI:1407821903
Name:EL-HITAMY, WALEED M (OD)
Entity Type:Individual
Prefix:
First Name:WALEED
Middle Name:M
Last Name:EL-HITAMY
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 1:900 RANCH ROAD 620 S
Mailing Address - Street 2:B112
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5615
Mailing Address - Country:US
Mailing Address - Phone:512-263-0225
Mailing Address - Fax:512-263-8590
Practice Address - Street 1:900 RANCH ROAD 620 S
Practice Address - Street 2:B112
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5615
Practice Address - Country:US
Practice Address - Phone:512-263-0225
Practice Address - Fax:512-263-8590
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05900T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU85273Medicare UPIN
TX83554EMedicare ID - Type UnspecifiedMEDICARE ID