Provider Demographics
NPI:1154982858
Name:CHOUDHARY, HADIA RIAZ (OD)
Entity type:Individual
Prefix:
First Name:HADIA
Middle Name:RIAZ
Last Name:CHOUDHARY
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 1:11345 PEMBROOKE SQ STE 105
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4804
Mailing Address - Country:US
Mailing Address - Phone:301-645-8120
Mailing Address - Fax:301-645-4740
Practice Address - Street 1:11345 PEMBROOKE SQ STE 105
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4804
Practice Address - Country:US
Practice Address - Phone:301-645-8120
Practice Address - Fax:301-645-4740
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist