Healthcare Provider Details

I. General information

NPI: 1336510767
Provider Name (Legal Business Name): BUFORD OPTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 BUFORD DR 100-A
BUFORD GA
30519-8764
US

IV. Provider business mailing address

3264 BUFORD DR 100-A
BUFORD GA
30519-8764
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-2365
  • Fax:
Mailing address:
  • Phone: 678-730-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: FAREED DOSANI
Title or Position: MEDICAL DIRECTROR
Credential: O.D.
Phone: 770-655-0989