Provider Demographics
NPI:1770862138
Name:HASSAN, SHAFRAZ (LDO)
Entity Type:Individual
Prefix:MR
First Name:SHAFRAZ
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 FAIRWAY DR
Mailing Address - Street 2:1ST, FLOOR
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3701
Mailing Address - Country:US
Mailing Address - Phone:561-355-8577
Mailing Address - Fax:561-355-8584
Practice Address - Street 1:7101 FAIRWAY DR
Practice Address - Street 2:1ST, FLOOR
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3701
Practice Address - Country:US
Practice Address - Phone:561-355-8577
Practice Address - Fax:561-355-8584
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5111156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician