Provider Demographics
NPI:1629304217
Name:ABDULLA, JABEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JABEEN
Middle Name:
Last Name:ABDULLA
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 1:1024 CENTRAL AVE N APT H11
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3074
Mailing Address - Country:US
Mailing Address - Phone:503-348-3238
Mailing Address - Fax:
Practice Address - Street 1:2219 S 37TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7473
Practice Address - Country:US
Practice Address - Phone:253-671-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60100670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist