Individual
DR. RAFAEL S COLLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
401 W ALLEGHENY AVE, PHILADELPHIA, PA 19133-3644
(215) 291-2500
(215) 291-2587
Mailing address
1412 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2908
(215) 684-5344
(215) 232-4093
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6393T
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001052997
—
PA
Enumeration date
10/03/2006
Last updated
12/15/2025
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