Provider Demographics
NPI:1508904335
Name:SHADPOOR, NASRINE A (OD)
Entity Type:Individual
Prefix:DR
First Name:NASRINE
Middle Name:A
Last Name:SHADPOOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452-A ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1560
Mailing Address - Country:US
Mailing Address - Phone:908-781-7707
Mailing Address - Fax:908-781-7708
Practice Address - Street 1:452-A ROUTE 206
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1560
Practice Address - Country:US
Practice Address - Phone:908-781-7707
Practice Address - Fax:908-781-7708
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU51887Medicare UPIN
NJ545648Medicare ID - Type Unspecified