Provider Demographics
NPI:1265604847
Name:SIDDIQUI, HUMERA (OD)
Entity type:Individual
Prefix:DR
First Name:HUMERA
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 CYPRESS PARKWAY
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759
Mailing Address - Country:US
Mailing Address - Phone:407-870-2405
Mailing Address - Fax:407-870-2409
Practice Address - Street 1:904 CYPRESS PKWY
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3456
Practice Address - Country:US
Practice Address - Phone:407-870-2405
Practice Address - Fax:407-870-2409
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist