Healthcare Provider Details

I. General information

NPI: 1295579381
Provider Name (Legal Business Name): CARROLLTON OPTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 S PARK ST
CARROLLTON GA
30117-4433
US

IV. Provider business mailing address

1313 S PARK ST
CARROLLTON GA
30117-4433
US

V. Phone/Fax

Practice location:
  • Phone: 770-832-1457
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. FAREED DOSANI
Title or Position: MANAGING MEMBER
Credential: OD
Phone: 770-655-0989