Provider Demographics
NPI:1659785475
Name:RAHMAN, TANZILA (OD)
Entity Type:Individual
Prefix:DR
First Name:TANZILA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TANZILA
Other - Middle Name:
Other - Last Name:MOSUMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5874 NW 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5874 NW 41ST WAY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4042
Practice Address - Country:US
Practice Address - Phone:561-866-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOPC4927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program