Individual
JACOB OMAR KHOUSSINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-7068
Mailing address
4620 FREY ST APT 115, MADISON, WI 53705-2903
(405) 808-6005
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
EC261086
ME
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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