Rafati, Jennifer Brave

Rafati, Jennifer Brave is an individual health care provider with primary practice located at 2100 Troy Rd Ste 104 , Edwardsville IL 62025-2595. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Rafati, Jennifer Brave can be contacted via phone (618) 656-8888.

Contact Information

Primary practice address
2100 Troy Rd Ste 104 Edwardsville IL 62025-2595
Phone: (618) 656-8888
Fax: (618) 656-8920
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2008017085 Missouri

Profile Details

NPI number 1184886731
LBN Legal business name Rafati, Jennifer Brave
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 25th, 2008
Last updated Mar 12th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184886731 NPPES
Illinois MEDICAID 0460100111
Illinois MEDICAID 1184886731

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