Healthcare Provider Details

I. General information

NPI: 1992642557
Provider Name (Legal Business Name): OPTICURE-MEDIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 HARBINS RD
DACULA GA
30019-1705
US

IV. Provider business mailing address

2431 HARBINS RD
DACULA GA
30019-1705
US

V. Phone/Fax

Practice location:
  • Phone: 484-866-8683
  • Fax:
Mailing address:
  • Phone: 484-866-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: KHUSHNOOD KHAN
Title or Position: OWNER
Credential:
Phone: 484-866-8683