Provider Demographics
NPI:1659561074
Name:AMIN, OPAL R (OD)
Entity Type:Individual
Prefix:DR
First Name:OPAL
Middle Name:R
Last Name:AMIN
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 1:5501B N IH 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2430
Mailing Address - Country:US
Mailing Address - Phone:512-452-5735
Mailing Address - Fax:512-452-3119
Practice Address - Street 1:5501B N IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2430
Practice Address - Country:US
Practice Address - Phone:512-452-5735
Practice Address - Fax:512-452-3119
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7112T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189005502Medicaid
TX189005502Medicaid