Provider Demographics
NPI:1265969109
Name:GHANEM, BILAL TAHER (OD)
Entity type:Individual
Prefix:DR
First Name:BILAL
Middle Name:TAHER
Last Name:GHANEM
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 1:18054 ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-5180
Mailing Address - Country:US
Mailing Address - Phone:440-268-0765
Mailing Address - Fax:
Practice Address - Street 1:18054 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5180
Practice Address - Country:US
Practice Address - Phone:440-268-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5402152W00000X
OHOPT.006705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist