Healthcare Provider Details

I. General information

NPI: 1821582818
Provider Name (Legal Business Name): IQRA QUDDUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 126TH ST
KEW GARDENS NY
11415-3312
US

IV. Provider business mailing address

296 LINCOLN PL
LAWRENCE NY
11559-1227
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-7773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008745-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9462TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: