Individual
VIKISHA HAZARIWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
790 CONCOURSE PKWY S STE 200, MAITLAND, FL 32751-6114
(407) 767-6411
Mailing address
790 CONCOURSE PKWY S STE 200, MAITLAND, FL 32751-6114
(407) 767-6411
(407) 767-8160
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
OS20971
FL
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
OS20971
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123331500
—
FL
01
—
S44W0
BCBS
FL
Enumeration date
05/24/2019
Last updated
10/16/2024
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