Provider Demographics
NPI:1407984388
Name:YACOUB, SIMA (OD)
Entity Type:Individual
Prefix:DR
First Name:SIMA
Middle Name:
Last Name:YACOUB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8748 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5471
Mailing Address - Country:US
Mailing Address - Phone:786-239-8279
Mailing Address - Fax:
Practice Address - Street 1:8748 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5471
Practice Address - Country:US
Practice Address - Phone:305-227-5467
Practice Address - Fax:305-227-5895
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3844152W00000X
CA11982T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000065000Medicaid
FL000065000Medicaid