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General NPI Number Information
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NPI Number | 1184354417
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Entity Type | Individual
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Provider Name | BAZLA SUKHERA OD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 592 SPRINGFIELD AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090-1002
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Country | US
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Telephone | 908-789-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 120 NEILSON ST APT 751
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1470
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Country | US
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Telephone | 847-962-0295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00711600
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License Number State | NJ
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