Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 5064 | MA |
Y | 152W00000X | Optometrist | 5220 | FL |
NPI | 1003212044 |
---|---|
Provider Name | Dr. Alvina Qureshi |
First Address | Marlborough, MA 01752-2426 |
Second Address | Tampa, FL 33612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2014 |
Last Update Date | 21/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5220 | FLORIDA STATE LICENSE (01) | FL |