Provider Demographics
NPI:1295963320
Name:HAFEZZADEH, NEKA (OD)
Entity type:Individual
Prefix:
First Name:NEKA
Middle Name:
Last Name:HAFEZZADEH
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 1:1610 PACE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-2238
Mailing Address - Country:US
Mailing Address - Phone:720-204-6891
Mailing Address - Fax:720-204-6852
Practice Address - Street 1:1610 PACE ST
Practice Address - Street 2:SUITE 600
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-2238
Practice Address - Country:US
Practice Address - Phone:720-204-6891
Practice Address - Fax:720-204-6852
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 2722152W00000X
CO2722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist