MEDICARE: DR. ASFAW KINDEYA NATU O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT002235	GA

General Provider Information

NPI Number	:	1962524033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASFAW KINDEYA NATU O.D.

Provider Business Mailing Address
First Line	:	6303 FIVE OAKS WAY
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-8175
Country	:	US
Telephone Number	:	954-732-4009
Fax Number	:	404-636-5959

Provider Business Practice Location Address
First Line	:	2050 LAWRENCEVILLE HWY STE D50
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-4316
Country	:	US
Telephone Number	:	404-325-5300
Fax Number	:	404-636-5959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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