Provider Demographics
NPI:1467870527
Name:ABBASI, YELISSA VELAZQUEZ (OD)
Entity Type:Individual
Prefix:DR
First Name:YELISSA
Middle Name:VELAZQUEZ
Last Name:ABBASI
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 1:92-1021 KOIO DR APT A
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2281
Mailing Address - Country:US
Mailing Address - Phone:787-233-5126
Mailing Address - Fax:
Practice Address - Street 1:92-1021 KOIO DR APT A
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2281
Practice Address - Country:US
Practice Address - Phone:787-233-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD 786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist