Healthcare Provider Details

I. General information

NPI: 1972550622
Provider Name (Legal Business Name): HUSSEIN WAFAPOOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1567 HAYLEY LN SUITE 101
FORT MYERS FL
33907-2109
US

IV. Provider business mailing address

1567 HAYLEY LN SUITE 101
FORT MYERS FL
33907-2109
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-3337
  • Fax: 239-936-2394
Mailing address:
  • Phone: 239-337-3337
  • Fax: 239-936-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number16742
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME9609
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME9609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: