Provider Demographics
NPI:1629141254
Name:EBRAHIM, AMINA (OD)
Entity Type:Individual
Prefix:DR
First Name:AMINA
Middle Name:
Last Name:EBRAHIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMINA
Other - Middle Name:
Other - Last Name:JAMAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7325 PLUMAS PL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-0211
Mailing Address - Country:US
Mailing Address - Phone:773-370-8090
Mailing Address - Fax:
Practice Address - Street 1:2023 W MCDERMOTT DR
Practice Address - Street 2:SUITE 290
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4676
Practice Address - Country:US
Practice Address - Phone:972-649-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009442152W00000X
TX8614T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU92375Medicare UPIN