Individual
LU'AIE HUSAM DIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
1001 N GRAND AVE, TAHLEQUAH, OK 74464-7017
(918) 444-4031
Mailing address
772 NE AUTUMNCREEK WAY APT O208, HILLSBORO, OR 97006-8743
(806) 674-7661
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3257
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2024
Last updated
07/23/2024
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