Provider Demographics
NPI:1912567629
Name:HASAN, SABAH AMIR (OD)
Entity Type:Individual
Prefix:
First Name:SABAH
Middle Name:AMIR
Last Name:HASAN
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 1:1051 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4959
Mailing Address - Country:US
Mailing Address - Phone:713-322-5083
Mailing Address - Fax:
Practice Address - Street 1:4850 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9718
Practice Address - Country:US
Practice Address - Phone:713-322-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9657T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist