Provider Demographics
NPI:1790495323
Name:GOHAR, HIBA JAVED (OD)
Entity Type:Individual
Prefix:
First Name:HIBA
Middle Name:JAVED
Last Name:GOHAR
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 1:9324 MERLOT CIR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-2628
Mailing Address - Country:US
Mailing Address - Phone:813-842-2602
Mailing Address - Fax:
Practice Address - Street 1:11391 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2904
Practice Address - Country:US
Practice Address - Phone:813-413-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist