Provider Demographics
NPI:1346779147
Name:NAQVI, AMBER FATIMA (OD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:FATIMA
Last Name:NAQVI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:FATIMA
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8038 MACINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5336
Mailing Address - Country:US
Mailing Address - Phone:815-332-6800
Mailing Address - Fax:
Practice Address - Street 1:8038 MACINTOSH LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5336
Practice Address - Country:US
Practice Address - Phone:153-326-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011496152W00000X, 152WL0500X
NY008568152W00000X
CA34213TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist