Healthcare Provider Details

I. General information

NPI: 1497753701
Provider Name (Legal Business Name): JOSEPH ROUW OD, FAAO, FCOVD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 HAMILTON CREEK PKWY STE 120
DACULA GA
30019-7205
US

IV. Provider business mailing address

3518 HABERSHAM CLUB DR
CUMMING GA
30041-8003
US

V. Phone/Fax

Practice location:
  • Phone: 770-904-0979
  • Fax: 470-655-7914
Mailing address:
  • Phone: 678-448-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1441
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2581
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2353
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: