Provider Demographics
NPI:1073521092
Name:ELHAFFAR, SADAF RAZI (OD)
Entity Type:Individual
Prefix:
First Name:SADAF
Middle Name:RAZI
Last Name:ELHAFFAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SADAF
Other - Middle Name:
Other - Last Name:RAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2801 LEMMON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2356
Mailing Address - Country:US
Mailing Address - Phone:214-754-0000
Mailing Address - Fax:214-379-1849
Practice Address - Street 1:2801 LEMMON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2356
Practice Address - Country:US
Practice Address - Phone:214-754-0000
Practice Address - Fax:214-379-1849
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06649TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175638901Medicaid
TX8L27453Medicare PIN
TX8L27454Medicare PIN
V05789Medicare UPIN
TX8D6745Medicare PIN