Provider Demographics
NPI:1811419914
Name:ABBAS, KOMAL (OD)
Entity Type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:
Last Name:ABBAS
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 1:84 CORONA CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2854
Mailing Address - Country:US
Mailing Address - Phone:732-407-9890
Mailing Address - Fax:
Practice Address - Street 1:3710 ROUTE 9 S STE 1501
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4805
Practice Address - Country:US
Practice Address - Phone:732-780-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00674100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist