Provider Demographics
NPI:1497161640
Name:HAYYAT, MAHMOUD A (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:A
Last Name:HAYYAT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 EXCHANGE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4464
Mailing Address - Country:US
Mailing Address - Phone:802-388-4456
Mailing Address - Fax:
Practice Address - Street 1:1330 EXCHANGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4464
Practice Address - Country:US
Practice Address - Phone:802-388-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT028.0000176156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician