Provider Demographics
NPI:1154459451
Name:JAFFER, RIZWAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:
Last Name:JAFFER
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 1:14406 AYERS ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7596
Mailing Address - Country:US
Mailing Address - Phone:281-416-7047
Mailing Address - Fax:713-481-5456
Practice Address - Street 1:345 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4933
Practice Address - Country:US
Practice Address - Phone:281-416-7047
Practice Address - Fax:281-416-7047
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB139875OtherMEDICARE PTAN