Provider Demographics
NPI:1689608861
Name:QOTAYNAH, ABDULWAHED HAMOUD (OD)
Entity Type:Individual
Prefix:DR
First Name:ABDULWAHED
Middle Name:HAMOUD
Last Name:QOTAYNAH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ABDUL
Other - Middle Name:
Other - Last Name:QOTAYNAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7850 MENTOR AVE
Mailing Address - Street 2:SUITE 368
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5520
Mailing Address - Country:US
Mailing Address - Phone:440-974-6793
Mailing Address - Fax:
Practice Address - Street 1:7850 MENTOR AVE
Practice Address - Street 2:SUITE 368
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5520
Practice Address - Country:US
Practice Address - Phone:440-974-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2390087Medicaid
OH4133491Medicare ID - Type Unspecified
OH2390087Medicaid