Healthcare Provider Details

I. General information

NPI: 1013331750
Provider Name (Legal Business Name): REEMA GOSALIA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 PEACHTREE RD NW STE 301
ATLANTA GA
30305-2193
US

IV. Provider business mailing address

PO BOX 207173
DALLAS TX
75320-7173
US

V. Phone/Fax

Practice location:
  • Phone: 404-869-5551
  • Fax: 404-869-5181
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008095
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002842
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: