Provider Demographics
NPI:1811545965
Name:FATIMA, HIRA NAWAL (OD)
Entity Type:Individual
Prefix:DR
First Name:HIRA
Middle Name:NAWAL
Last Name:FATIMA
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 1:4957 IVYVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7167
Mailing Address - Country:US
Mailing Address - Phone:504-222-5412
Mailing Address - Fax:
Practice Address - Street 1:1600 N BECHTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1572
Practice Address - Country:US
Practice Address - Phone:504-222-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT006741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist