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Individual

DR. JENNIFER BRAVE RAFATI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
2100 TROY RD STE 104, EDWARDSVILLE, IL 62025-2595
(618) 656-8888
(618) 656-8920
Mailing address
2100 TROY RD STE 104, EDWARDSVILLE, IL 62025-2595
(618) 656-8888
(618) 656-8920

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2008017085
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0460100111
IL
05
1184886731
MO
Enumeration date
06/25/2008
Last updated
03/12/2013
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