Provider Demographics
NPI:1063309631
Name:HADDAD, WISSAM (OD)
Entity type:Individual
Prefix:DR
First Name:WISSAM
Middle Name:
Last Name:HADDAD
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 1:185 ATHENS BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1601
Mailing Address - Country:US
Mailing Address - Phone:716-515-3129
Mailing Address - Fax:
Practice Address - Street 1:2810 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9419
Practice Address - Country:US
Practice Address - Phone:716-834-6000
Practice Address - Fax:716-834-3245
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist