Healthcare Provider Details

I. General information

NPI: 1962854653
Provider Name (Legal Business Name): HIRA REHMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HIRA REHMAN JAAT OD

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 NW FEDERAL HWY
STUART FL
34994-9253
US

IV. Provider business mailing address

9060 SW 54TH PL
COOPER CITY FL
33328-5852
US

V. Phone/Fax

Practice location:
  • Phone: 772-266-7751
  • Fax:
Mailing address:
  • Phone: 954-326-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 5243
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: