Provider Demographics
NPI:1063241834
Name:NASRIN, COMA (OD)
Entity type:Individual
Prefix:
First Name:COMA
Middle Name:
Last Name:NASRIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 STREET RD APT J6
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2017
Mailing Address - Country:US
Mailing Address - Phone:215-303-6429
Mailing Address - Fax:
Practice Address - Street 1:9171 ROOSEVELT BLVD STE G
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2218
Practice Address - Country:US
Practice Address - Phone:215-673-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist