Provider Demographics
NPI:1922300797
Name:BASHOUR, GHAITH ADEEB (LDO)
Entity Type:Individual
Prefix:MR
First Name:GHAITH
Middle Name:ADEEB
Last Name:BASHOUR
Suffix:
Gender:M
Credentials:LDO
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 84TH ST UNIT 8
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4922
Mailing Address - Country:US
Mailing Address - Phone:305-362-3937
Mailing Address - Fax:305-362-3948
Practice Address - Street 1:2800 W 84TH ST UNIT 8
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4922
Practice Address - Country:US
Practice Address - Phone:305-362-3937
Practice Address - Fax:305-362-3948
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 2639156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician