MEDICARE: TASNIM NOOR 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	046.011073	IL
2	152W00000X	Optometrist	008743	NY
3	152W00000X	Optometrist	27OA00678900	NJ
4	152W00000X	Optometrist	FL5986	FL

General Provider Information

NPI Number	:	1710429089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASNIM NOOR O.D.

Provider Business Mailing Address
First Line	:	8021 PETERS RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-4053
Country	:	US
Telephone Number	:	954-224-8642
Fax Number	:

Provider Business Practice Location Address
First Line	:	2471 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6853
Country	:	US
Telephone Number	:	954-943-3606
Fax Number	:

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

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	02/12/2025

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