Provider Demographics
NPI:1639104318
Name:OMAR, OSAMA HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:HASSAN
Last Name:OMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N WESTMONTE DR STE F
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3360
Mailing Address - Country:US
Mailing Address - Phone:407-389-0800
Mailing Address - Fax:407-389-1880
Practice Address - Street 1:220 N WESTMONTE DR STE F
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3360
Practice Address - Country:US
Practice Address - Phone:407-389-0800
Practice Address - Fax:407-389-1880
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210778-1207W00000X
CAG83074207W00000X
FLME79154207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011492200Medicaid
FL58674OtherBCBS ID
FL262941100Medicaid
FLF96523Medicare UPIN