Provider Demographics
NPI:1548736754
Name:ALI, MEHWISH MEHBOOB (OD)
Entity Type:Individual
Prefix:
First Name:MEHWISH
Middle Name:MEHBOOB
Last Name:ALI
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 1:7931 QUADE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2332
Mailing Address - Country:US
Mailing Address - Phone:512-961-0569
Mailing Address - Fax:
Practice Address - Street 1:19075 I 45 S STE 121B
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8772
Practice Address - Country:US
Practice Address - Phone:936-271-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3820152W00000X
MO2023021434152W00000X
TN3811152W00000X
WI3822-35152W00000X
TX9469T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist