Individual provider Active NPI

Nour Abu-Haltam, OD

  • Optometrist
  • Vancouver, WA
National Provider Identifier
1194602037
Registry record updated Aug 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4789 Issued in OR
Practice address
8700 NE Vancouver Mall Dr Ste 232
Vancouver, WA 98662-6418
Phone
(360) 882-9355
NPI assigned
Aug 20, 2025
Last updated
Aug 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4789 OR Primary

Addresses

Primary practice location

8700 NE Vancouver Mall Dr Ste 232
Vancouver, WA 98662-6418

Mailing address

8700 NE Vancouver Mall Dr Ste 232
Vancouver, WA 98662-6418
Phone (360) 882-9355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251126001447 WA Practitioner - Optometry 5294227286 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr Crystal Edison OD and Associates PLLCGroup PAC ID 0547666315, 2 clinicians

Practice addresses (Care Compare)

8700 NE Vancouver Mall Dr
Suite 232
Vancouver, WA 98662-6418
Phone (360) 882-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4789ORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lena Barghouti-Afranji & Associates Professional Corp Optometrist CurrentSince Aug 25, 2025 Accepting new patients
Dr Crystal Edison OD & Associates PLLC Optometrist CurrentSince Sep 9, 2025 Accepting new patients

Locations

8700 NE Vancouver Mall Dr
Ste 232
Vancouver, WA 98662
Phone (360) 882-9355

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755648000000",
    "number": "1194602037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8700 NE VANCOUVER MALL DR STE 232",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626418",
            "telephone_number": "360-882-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 NE VANCOUVER MALL DR STE 232",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626418",
            "telephone_number": "360-882-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABU-HALTAM",
        "first_name": "NOUR",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-20",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "4789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.