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General NPI Number Information
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NPI Number | 1891687216
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Entity Type | Organization
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Legal Business Name | HZRA OPTOMETRY, LLC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 5711 YMCA PARK DR E
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City | FORT WAYNE
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State | IN
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Zip | 46835-3279
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Country | US
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Telephone | 224-999-3129
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Fax |
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Provider Business Mailing Address
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Address Line | 5711 YMCA PARK DR E
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City | FORT WAYNE
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State | IN
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Zip | 46835-3279
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Country | US
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Telephone | 260-200-4464
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Fax | 260-374-0090
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Authorized Official
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Title or Position | MEMBER
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Name | FAISAL RASOOLI
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Credential | O.D.
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Telephone | 224-999-3129
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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 |
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License Number State |
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