Provider Demographics
NPI:1588541221
Name:DAISSAOUI, ELIAS
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:DAISSAOUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14935 S RICHMOND AVE APT 1736
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1596
Mailing Address - Country:US
Mailing Address - Phone:863-397-5731
Mailing Address - Fax:
Practice Address - Street 1:14935 S RICHMOND AVE APT 1736
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1596
Practice Address - Country:US
Practice Address - Phone:863-397-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist