Provider Demographics
NPI:1013765452
Name:AL-QAWASMI, SABA
Entity type:Individual
Prefix:
First Name:SABA
Middle Name:
Last Name:AL-QAWASMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41434 W VILLAGE GREEN BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3864
Mailing Address - Country:US
Mailing Address - Phone:708-745-8979
Mailing Address - Fax:
Practice Address - Street 1:35169 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1660
Practice Address - Country:US
Practice Address - Phone:734-728-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist