Provider Demographics
NPI:1871223644
Name:SROUR, HADY H (OD)
Entity Type:Individual
Prefix:DR
First Name:HADY
Middle Name:H
Last Name:SROUR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W BIG BEAVER RD STE Q-111
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3248
Mailing Address - Country:US
Mailing Address - Phone:248-639-4015
Mailing Address - Fax:
Practice Address - Street 1:2800 W BIG BEAVER RD STE Q-111
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3248
Practice Address - Country:US
Practice Address - Phone:248-639-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist