MEDICARE: HADIA RIAZ CHOUDHARY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA2687	MD

General Provider Information

NPI Number	:	1154982858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADIA RIAZ CHOUDHARY O.D.

Provider Business Mailing Address
First Line	:	11345 PEMBROOKE SQ STE 105
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4804
Country	:	US
Telephone Number	:	301-645-8120
Fax Number	:	301-645-4740

Provider Business Practice Location Address
First Line	:	11345 PEMBROOKE SQ STE 105
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4804
Country	:	US
Telephone Number	:	301-645-8120
Fax Number	:	301-645-4740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	11/27/2023

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