Provider Demographics
NPI:1184346413
Name:UPPAL, ABYAZ (OD)
Entity type:Individual
Prefix:
First Name:ABYAZ
Middle Name:
Last Name:UPPAL
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 1:3 GLOUCESTER DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2607
Mailing Address - Country:US
Mailing Address - Phone:917-572-7684
Mailing Address - Fax:
Practice Address - Street 1:1515 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6509
Practice Address - Country:US
Practice Address - Phone:908-769-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00717000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty