Provider Demographics
NPI:1932753787
Name:GHAFOOR, ATKA (OD)
Entity Type:Individual
Prefix:
First Name:ATKA
Middle Name:
Last Name:GHAFOOR
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 1:6820 ASHBROOK DR APT 310
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3489
Mailing Address - Country:US
Mailing Address - Phone:630-863-3225
Mailing Address - Fax:
Practice Address - Street 1:3200 SEVERN AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4793
Practice Address - Country:US
Practice Address - Phone:504-887-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1900-836AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist