Provider Demographics
NPI:1700369261
Name:RAJHA, MICHELINE M (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELINE
Middle Name:M
Last Name:RAJHA
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 1:2030 W TILGHMAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4354
Mailing Address - Country:US
Mailing Address - Phone:610-432-3258
Mailing Address - Fax:610-289-2100
Practice Address - Street 1:2030 W TILGHMAN ST STE 101
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4354
Practice Address - Country:US
Practice Address - Phone:610-432-3258
Practice Address - Fax:610-289-2100
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-G003435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOE-G003435OtherLICENSE NUMBER