Abdul Qotaynah O.D., Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5148 T2047 Issued in OH

Legal business name

ABDUL QOTAYNAH O.D., INC.

Practice address

7850 Mentor Ave
Suite 368
Mentor, OH 44060-5520

Phone

(440) 974-6793

Fax

(440) 974-6621

NPI assigned

Mar 1, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Abdulwahed Hamoud Qotaynah, O.D.NPI 1689608861

Title

Owner

Phone

(440) 974-6793

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Abdulwahed Hamoud Qotaynah, O.D.

  • Optometrist
  • Mentor, OH
  • NPI 1689608861
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740318542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7850 MENTOR AVE",
            "address_2": "SUITE 368",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605520",
            "telephone_number": "440-974-6793",
            "fax_number": "440-974-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7850 MENTOR AVE",
            "address_2": "SUITE 368",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605520",
            "telephone_number": "440-974-6793",
            "fax_number": "440-974-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABDUL QOTAYNAH O.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "QOTAYNAH",
        "authorized_official_first_name": "ABDULWAHED",
        "authorized_official_middle_name": "HAMOUD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-974-6793",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5148 T2047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2390087",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Mentor, OH
• Providers in Mentor, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.