Provider Demographics
NPI:1881681542
Name:OHAN, FARIS G (O D)
Entity type:Individual
Prefix:DR
First Name:FARIS
Middle Name:G
Last Name:OHAN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 FM 359 RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2049
Mailing Address - Country:US
Mailing Address - Phone:281-232-8257
Mailing Address - Fax:281-232-0894
Practice Address - Street 1:4000 AVENUE I
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-3904
Practice Address - Country:US
Practice Address - Phone:281-342-4664
Practice Address - Fax:281-232-0894
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06557TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019274201Medicaid
TX168288201Medicaid
TX613466Medicare PIN
TX00E24GMedicare ID - Type UnspecifiedGROUP #
TX019274201Medicaid
TX8C2190Medicare ID - Type UnspecifiedINDIVIDUAL #