Provider Demographics
NPI:1750395307
Name:MOMIN, AZMINA (OD)
Entity type:Individual
Prefix:DR
First Name:AZMINA
Middle Name:
Last Name:MOMIN
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 1:11579 S HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4932
Mailing Address - Country:US
Mailing Address - Phone:281-565-3937
Mailing Address - Fax:
Practice Address - Street 1:11579 S HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4932
Practice Address - Country:US
Practice Address - Phone:281-565-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5585TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81024QOtherBLUE CROSS BLUE SHIELD
TX155529401Medicaid
TX81024QOtherBLUE CROSS BLUE SHIELD
TX8C9125Medicare PIN