Provider Demographics
NPI:1780566430
Name:SIDDIK, ABU BAKKER (OD)
Entity type:Individual
Prefix:
First Name:ABU
Middle Name:BAKKER
Last Name:SIDDIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W SUNRISE HWY # 100
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1011
Mailing Address - Country:US
Mailing Address - Phone:516-791-2790
Mailing Address - Fax:
Practice Address - Street 1:260 W SUNRISE HWY # 100
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1011
Practice Address - Country:US
Practice Address - Phone:516-791-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist