Provider Demographics
NPI:1679167860
Name:UDDIN RAFAT, IQRA (OD)
Entity type:Individual
Prefix:
First Name:IQRA
Middle Name:
Last Name:UDDIN RAFAT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:IQRA
Other - Middle Name:
Other - Last Name:UDDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:5648 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3045
Mailing Address - Country:US
Mailing Address - Phone:732-822-6496
Mailing Address - Fax:
Practice Address - Street 1:5648 CRICKET LN
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3045
Practice Address - Country:US
Practice Address - Phone:732-822-6496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist