Healthcare Provider Details

I. General information

NPI: 1821927005
Provider Name (Legal Business Name): SAFA ALJEBOURE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 LAKESIDE AVE APT 1
WORCESTER MA
01603-2931
US

IV. Provider business mailing address

28 LAKESIDE AVE APT 1
WORCESTER MA
01603-2931
US

V. Phone/Fax

Practice location:
  • Phone: 832-279-9643
  • Fax:
Mailing address:
  • Phone: 832-279-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8423
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: