Provider Demographics
NPI:1740601087
Name:INAYATALI, FAHEEM (OD, MBA)
Entity Type:Individual
Prefix:DR
First Name:FAHEEM
Middle Name:
Last Name:INAYATALI
Suffix:
Gender:M
Credentials:OD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7855
Mailing Address - Country:US
Mailing Address - Phone:713-777-2020
Mailing Address - Fax:
Practice Address - Street 1:10101 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7855
Practice Address - Country:US
Practice Address - Phone:713-777-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8339TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist