Individual
KULSOOM T. MURTAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2015 WATERSIDE RD, PRINCE GEORGE, VA 23875-1265
(804) 733-7300
(804) 733-7390
Mailing address
400 WESTHAMPTON STA, RICHMOND, VA 23226-3330
(804) 287-4200
(804) 287-4210
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001931
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0618001931
STATE LICENSE
VA
01
—
200000002790
PHPMM
MI
01
—
900C363570
BLUE CROSS BLUE SHIELD
MI
01
—
KM003908
STATE LICENSE NUMBER
MI
Enumeration date
08/12/2006
Last updated
02/14/2012
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