Provider Demographics
NPI:1932395274
Name:DR WAFA ABDULRAZZAQ PA
Entity Type:Organization
Organization Name:DR WAFA ABDULRAZZAQ PA
Other - Org Name:EYE Q OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULRAZZAQ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-646-3812
Mailing Address - Street 1:1411 NW 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6626
Mailing Address - Country:US
Mailing Address - Phone:954-646-3812
Mailing Address - Fax:
Practice Address - Street 1:8711 STIRLING RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5932
Practice Address - Country:US
Practice Address - Phone:954-434-1414
Practice Address - Fax:954-434-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3982305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service