Organization
COLLAZO OPHTHALMOLOGY & OPTOMETRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL S COLAZZO OD (OPTOMETRIST)
(215) 455-1010
Entity
Organization
Contact information
Practice address
4231 N 5TH ST, PHILADELPHIA, PA 19140-2602
(215) 455-1010
Mailing address
PO BOX 1141, BALA CYNWYD, PA 19004-5141
(215) 455-1010
(215) 732-8656
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OE006393T
PA
207W00000X
Ophthalmology Physician
OE006393T
PA
213E00000X
Podiatrist
OE006393T
PA
Other
Enumeration date
01/25/2012
Last updated
04/25/2013
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